Prognostic factors influencing mortality rates of adult Thai patients hospitalized with chronic kidney disease
| Variables | No. of patients (individuals) | Dead individuals and mortality rate (%) | Crude odds ratio (95% CI) | P | Adjusted odds ratio* (95% CI) | P |
|---|---|---|---|---|---|---|
| Sex | ||||||
| Female | 66,134 | 6,814(10.3) | 1 | 1 | ||
| Male | 62,204 | 6,941(11.2) | 1.10(1.05-1.14) | <0.001 | 1.07(1.03-1.11) | 0.001 |
| Age (years) | ||||||
| 19-30 | 1,869 | 189(10.1) | 1 | 1 | ||
| 31-40 | 4,135 | 400(9.7) | 0.95(0.79-1.14) | 0.60 | 1.13(0.92-1.39) | 0.23 |
| 41-50 | 10,556 | 1,127(10.7) | 1.06(0.90-1.25) | 0.47 | 1.20(1.00-1.45) | 0.049 |
| 51-60 | 23,073 | 2,318(10.0) | 0.99(0.85-1.16) | 0.93 | 1.09(0.91-1.30) | 0.36 |
| 61-70 | 32,837 | 3,277(10.0) | 0.98(0.84-1.15) | 0.85 | 1.08(0.91-1.29) | 0.38 |
| 71-80 | 37,727 | 4,039(10.7) | 1.07(0.91-1.24) | 0.42 | 1.19(0.99-1.41) | 0.06 |
| >80 | 18,141 | 2,405(13.3) | 1.36(1.16-1.59) | <0.001 | 1.52(1.27-1.81) | <0.001 |
| Comorbidities | ||||||
| Diabetes mellitus (yes/no) | 58,427/69,911 | 6,795(11.6)/6,960(10.0 | 1.19(1.15-1.23) | <0.001 | 1.13(1.08-1.19) | <0.001 |
| Ischemic heart disease (yes/no) | 19,264/109,074 | 3,178(16.5)/10,577(9.7) | 1.84(1.76-1.92) | <0.001 | 1.64(1.55-1.73) | <0.001 |
| Heart failure (yes/no) | 18,174/110,164 | 3,277(18.0)/10,478(9.5) | 2.09(2.01-2.18) | <0.001 | 1.42(1.35-1.50) | <0.001 |
| Sepsis (yes/no) | 16,792/111,546 | 6,146(36.6)/7,609(6.8) | 7.89(7.58-8.20) | <0.001 | 4.96(4.75-5.19) | <0.001 |
| Pneumonia (yes/no) | 13,247/115,091 | 3,860(29.1)/9,895(8.6) | 4.37(4.19-4.56) | <0.001 | 1.81(1.72-1.91) | <0.001 |
| AKI plus preexisting CKD (yes/no) | 11,367/116,971 | 2,972(26.1)/10,783(9.2) | 3.49(3.33-3.65) | <0.001 | 1.63(1.54-1.72) | <0.001 |
| Stroke (yes/no) | 9,527/118,811 | 2,071(21.7)/11,684(9.8) | 2.55(2.42-2.68) | <0.001 | 2.16(2.03-2.30) | <0.001 |
| Respiratory failure (yes/no) | 10,596/117,742 | 4,707(44.4)/9,048(7.7) | 9.60(9.19-10.03) | <0.001 | 4.14(3.94-4.36) | <0.001 |
| Complications | ||||||
| Anemia requiring blood Transfusion (yes/no) 38,730/89,608 | 5,916(15.3)/7,839(8.7) | 1.88(1.81-1.95) | <0.001 | 1.21(1.16-1.27) | <0.001 | |
| Hyperkalemia (yes/no) | 19,165/109,173 | 3,728(19.5)/10,027(9.2) | 2.39(2.29-2.49) | <0.001 | 1.51(1.44-1.59) | <0.001 |
| Volume overload (yes/no) | 15,213/113,125 | 2,831(18.6)/10,924(9.7) | 2.14(2.04-2.24) | <0.001 | 1.25(1.18-1.32) | <0.001 |
| Metabolic acidosis (yes/no) | 10,561/117,777 | 2,799(26.5)/10,956(9.3) | 3.52(3.35-3.69) | <0.001 | 1.74(1.64-1.84) | <0.001 |
Characteristics of patients hospitalized with chronic kidney disease
| Characteristics of admitted CKD patients | |
|---|---|
| Number of adult patients (individuals) | 128,338 |
| Number of admissions (times) | 236,439 |
| Age (mean ± SD) years | 65.5 ± 13.9 |
| Sex (male/female) | 1/1.14 |
| Common comorbidities (% of admissions) | |
| Hypertension | 53.1 |
| Diabetes mellitus | 43.0 |
| Hyperlipidemia | 13.2 |
| Ischemic heart disease | 12.4 |
| Heart failure | 10.5 |
| Gout | 8.3 |
| Sepsis | 7.8 |
| Pneumonia | 6.2 |
| AKI on preexisting CKD | 5.1 |
| Diarrhea | 5.1 |
| Stroke | 5.0 |
| Respiratory failure | 4.8 |
| Complications (% of admissions) | |
| Anemia requiring blood transfusion | 24.4 |
| Hyperkalemia | 9.9 |
| Volume overload | 9.3 |
| Metabolic acidosis | 5.0 |
| Dialysis treatment (% of admissions) | |
| Hemodialysis | 7.3 |
| Peritoneal dialysis | 1.9 |
| Length of stay (days) | |
| Median (25th –75th percentile) | 3.0 (2.0-6.0) |
| Hospital charge (baht) | |
| Mean ± SD | 20,980 ± 126,985 |
| Median (25th –75th percentile) | 7,360 (3,866-16,599) |
| Mortality (%) | 10.7 |
Factors influencing high hospital charges (>50,000 baht) among Thai adult patients hospitalized with CKD
| Variables | No. of admissions (times) | No. of high cost admission (%) | Crude odds ratio (95% CI) | P | Adjusted odds ratio (95% CI) | P |
|---|---|---|---|---|---|---|
| Sex | ||||||
| Female | 126,027 | 8,490(6.7) | 1 | <0.001 | ||
| Male | 110,412 | 9,662(8.8) | 1.31(1.27–1.36) | 1.29(1.25–1.34) | ||
| Age (years) | ||||||
| 19–30 | 4,376 | 405(9.3) | 1 | 1 | ||
| 31–40 | 8,392 | 715(8.5) | 0.92(0.80–1.06) | 0.24 | 1.03(0.88–1.20) | 0.72 |
| 41–50 | 22,172 | 1,682(7.6) | 0.81 (0.72–0.92) | <0.001 | 0.90(0.78–1.03) | 0.13 |
| 51–60 | 46,571 | 3,408(7.3) | 0.77(0.68–0.86) | <0.001 | 0.81(0.71–0.92) | 0.002 |
| 61–70 | 62,672 | 4,324(6.9) | 0.72(0.64–0.81) | <0.001 | 0.75 (0.66–0.85) | <0.001 |
| 71–80 | 64,288 | 5,065 (7.9) | 0.82(0.72–0.92) | <0.001 | 0.84(0.74–0.96) | 0.01 |
| >80 | 27,968 | 2,553(9.1) | 0.95 (0.84–1.07) | 0.40 | 0.95(0.83–1.09) | 0.48 |
| Comorbidities | ||||||
| Hypertension (yes/no) | 125,565/110,874 | 11,037(8.8)/7,115(6.4) | 1.38(1.34–1.42) | <0.001 | 1.21(1.17–1.26) | <0.001 |
| Diabetes mellitus (yes/no) | 101,664/134,775 | 8,775 (8.6)/9,377 (7.0) | 1.27(1.23–1.31) | <0.001 | 1.20(1.16–1.25) | <0.001 |
| Hyperlipidemia (yes/no) | 31,229/205,210 | 3,449(11.0)/14,703(7.2) | 1.51(1.45–1.57) | <0.001 | 1.38(1.32–1.45) | <0.001 |
| Ischemic heart disease (yes/no) | 29,272/207,167 | 4,406(15.1)/13,746(6.6) | 2.42(2.33–2.51) | <0.001 | 2.35 (2.24–2.45) | <0.001 |
| Heart failure (yes/no) | 24,915/211,524 | 2,679(10.8)/15,473(7.3) | 1.53(1.46–1.60) | <0.001 | 1.13(1.07–1.19) | <0.001 |
| Sepsis (yes/no) | 18,528/217,911 | 4,586(24.8)/13,566(6.2) | 4.62(4.44–4.79) | <0.001 | 2.87(2.74–3.00) | <0.001 |
| Pneumonia (yes/no) | 14,732/221,707 | 4,004(27.2)/14,148(6.4) | 5.18(4.98–5.40) | <0.001 | 3.18(3.03–3.34) | <0.001 |
| AKI plus preexisting CKD (yes/no) | 12,133/224,306 | 3,351(27.6)/14,801(6.6) | 5.09(4.88–5.31) | <0.001 | 2.83 (2.69–2.98) | <0.001 |
| Stroke (yes/no) | 11,886/224,553 | 2,313(19.5)/15,839(7.1) | 2.97(2.83–3.12) | <0.001 | 2.41 (2.27–2.55) | <0.001 |
| Respiratory failure (yes/no) | 11,347/225,092 | 3,080(27.1)/15,072(6.7) | 5.02(4.80–5.25) | <0.001 | 2.10(1.99–2.22) | <0.001 |
| Complications | ||||||
| Anemia requiring blood Transfusion (yes/no) | 57,727/178,712 | 7,442(12.9)/10,710(6.0) | 2.38(2.31–2.46) | <0.001 | 2.13(2.06–2.21) | <0.001 |
| Hyperkalemia (yes/no) | 23,505/212,934 | 2,532(10.8)/15,620(7.3) | 1.57(1.51–1.64) | <0.001 | 1.09(1.03–1.14) | 0.002 |
| Metabolic acidosis (yes/no) | 11,897/224,542 | 1,549(13.0)/16,603(7.4) | 1.90(1.80–2.00) | <0.001 | 1.03(0.96–1.10) | 0.42 |
| Mode of dialysis | ||||||
| Hemodialysis | 17,143/219,296 | 5,239(30.6)/12,913(5.9) | 6.45 (6.22–6.70) | <0.001 | 5.16(4.94–5.39) | <0.001 |
| Peritoneal dialysis | 4,584/231,855 | 1,170(25.5)/16,982(7.3) | 4.16(3.89–4.46) | <0.001 | 3.40(3.14–3.69) | <0.001 |
Length of hospital stay and hospital charges for hospitalized patients with chronic kidney disease and comorbidities, complications, and dialysis
| Length of stay (days) | Total hospital charge (baht) | Hospital charge per day (baht) | ||||
|---|---|---|---|---|---|---|
| Median (25th–75th percentile) | Mean ± SD | Median (25th–75th percentile) | Mean ± SD | Median (25th–75th percentile) | ||
| Comorbidities | Hypertension | 4(2–7) | 23,333 ±151,929 | 7,759(4,028–17,866) | 3,564 ±11,486 | 2,182(1,465–3,543) |
| Diabetes mellitus | 4(2–7) | 23,072 ±165,634 | 7,836(4,151–17,566) | 3,479 ±12,217 | 2,127(1,444–3,482) | |
| Hyperlipidemia | 4 (2–7) | 27,754 ±79,165 | 8,767(4,471–20,767) | 4,283 ±11,570 | 2,232(1,493–3,700) | |
| Ischemic heart disease | 4(2–8) | 37,732 ±106,752 | 11,478(5,510–27,252) | 5,924 ±15,359 | 2,729(1,782–4,597) | |
| Heart failure | 4(2–8) | 28,369 ±107,870 | 9,920(5,310–21,368) | 3,503 ±6,035 | 2,392(1,642–3,787) | |
| Gout | 4 (2–7) | 19,727 ±54,788 | 7,061 (3,709–15,541) | 2,989 ±5,738 | 1,930(1,323–3,095) | |
| Sepsis | 6 (3–13) | 54,187 ±140,151 | 19,293 (8,684–19,433) | 4,789 ±4,888 | 3,412(2,054–5,756) | |
| Pneumonia | 7(4–14) | 63,327 ±163,420 | 19,308(8,470–55,465) | 4,170± 3,747 | 3,118(1,901–5,143) | |
| AKI on pre-existing CKD | 7 (4–14) | 57,789 ±127,685 | 22,363(9,794–55,169) | 4,678 ±6,166 | 3,182(1,995–5,286) | |
| Diarrhea | 3(2–6) | 17,199 + 55,461 | 5,557(3,086–11,968) | 2,390 ±2,751 | 1,684(1,223–2,602) | |
| Stroke | 5(3–11) | 44,983 ±116,448 | 13,962(6,644–37,092) | 4,112 ±6,066 | 2,860(1,826–1,686) | |
| Respiratory failure | 5(2–11) | 55,515 ±121,600 | 23,262(10,459–54,127) | 5,923 ±5,509 | 4,691 (3,260–6,917) | |
| Complications | Anemia requiring | |||||
| blood transfusion | 4(2–8) | 29,857 ±97,687 | 9,234(4,591–23,990) | 3,569 ±4,830 | 2,600(1,828–3,950) | |
| Hyperkalemia | 4 (2–7) | 25,446 ±65,694 | 9,324(5,151–21,005) | 3,775 ±4,978 | 2,696(1,850–1,246) | |
| Volume overload | 4(2–7) | 24,277 ±315,227 | 8,960(4,955–19,631) | 3,391 ±21,033 | 2,372(1,635–3,770) | |
| Metallic acidosis | 4(2–8) | 27,833 ±63,349 | 11,010(5,679–25,701) | 4,432 ±5,591 | 2,942(1,866–5,215) | |
| Mode of dialysis | Hemodialysis | 8(4–15) | 66,302 ±245,694 | 27,847(13,424–61,410) | 5,864 ±92,303 | 3,470(2,301–5,473) |
| Peritoneal dialysis | 8(4–15) | 56,072 ±369,690 | 21,850(10,218–51,175) | 6,711 ±177,788 | 2,904(1,900–4,815) | |