PF730 CHRONIC RENAL FAILURE IN CHILDHOOD CANCER: AN INSIGHT FROM KIDS INPATIENT DATABASE

Abstract

Background:Chronic Renal Failure (CRF) is prevelant in oncology patients. CRF may pre‐exist cancer diagnosis, occur secondry to cancer infiltration, complicate chemotherapy and other toxic drugs or follow hematopoietic stem‐cell transplantation. CRF is associated with prolonged hospital stay, high healthcare cost and increased mortality. Despite the increased prevelance and these associations, the national rate and clinical outcome of CRF among pediatric oncology patients is not well described.Aims:Define CRF incidence and its health outcomes among pediatric oncology patients in the United States (U.S.).Methods:We performed a retrospective cohort analysis of the Health Cost and Utilization Project (HCUP) Kids’ Inpatient 2000–2012 Database (KID) for patient ≤ 20 years of age. Patients with principal diagnosis of acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), lymphomas (Hodgkin and non‐Hodgkin), brain tumor, neuroblastoma, bone tumors (Ewing's Sarcoma and Osteosarcoma) and hepatoblastoma were reviewed. Encounters for chemotherapy were excluded. Patients with medical diagnosis of CRF were identified using ICD‐9‐CM codes. We performed descriptive statistics to characterize the cohort in terms of demographic factors (age, race, sex, insurance type), hospital characteristics and comorbidities. Data weights were applied to sampled patients to provide national estimates. The in‐hospital mortality rate, total charges, and hospital length of stay (LOS) were compared between cancer patients with and without CRF using bivariable analyses.Results:A total of 266,113 admissions were included for analysis. The cohort was comprised of 1,035 patients with CRF, with an overall incidence 4 per 1,000 admissions. The median age was 15 years.51.5% of CKD patients were among the age group above 12‐year‐old. Males (57%), and whites (52.3%) were more commonly affected. South and Midwest regions (59.5%) of the U.S. had higher frequency of CRF. 15% of CRF complicated acute kidney injury (AKI). Lymphoma was the most common diagnosis associated with CRF (1.3%). Patients with CRF had significantly higher mortality rates (5.5% vs. 1.36%, p < 0.0001), longer median LOS (15 days vs. 4 days, p < 0.0001) in CRF patients complicated AKI and higher median total charges per hospitalization ($36,600 vs $18,856) when compared to patients without CRF.Summary/Conclusion:CRF in pediatric oncology patients is significantly associated with increased in‐hospital mortality and higher healthcare cost in pediatric oncology patients. Attention should be directed towards strategies to minimize risk of CRF in those population.