Abstract: FR-OR04
No Rest for the Wicked: The Complexity of Nephrology Inpatients Is Increasing over Time
Session Information
- CKD: Care Patterns and Novel Therapeutic Approaches
October 25, 2024 | Location: Room 25, Convention Center
Abstract Time: 05:00 PM - 05:10 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Ghimire, Anukul, University of Calgary, Calgary, Alberta, Canada
- Wiebe, Natasha, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Manns, Braden J., University of Calgary, Calgary, Alberta, Canada
- Hemmelgarn, Brenda, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Tonelli, Marcello, University of Calgary, Calgary, Alberta, Canada
Background
Patients seen by nephrologists are known to be more complex than those seen by other medical specialties. Anecdote suggests that the complexity of nephrology inpatients has increased over time, but this has not been studied. We assessed temporal trends in the complexity of inpatients seen by nephrologists.
Methods
We did a retrospective cohort study of all adults in Alberta, Canada who were seen by one or more nephrologists during a hospitalization between 2011-2020. We used validated algorithms applied to population-based administrative data to assess patient characteristics.
We evaluated 10 markers of complexity; 8 were measured in the year prior to admission to minimize the competing risk of mortality (presence of ≥10 comorbidities, >15 prescribed drugs, presence of a mental health condition, presence of frailty, number of physician specialties involved in care, number of individual physicians involved in care, ≥2 prior hospitalizations, and >5 emergency visits). We assessed all-cause death and placement in long-term care (LTC) during the year following admission. Differences over time were assessed using generalized linear models.
Results
Among 45,156 inpatients, median age remained stable at 65y over 2011-2020. The table shows the secular changes in the 10 complexity markers. The proportion with a mental health condition and the likelihood of placement in LTC remained stable, whereas the risk of mortality decreased. Complexity as assessed by the remaining 7 markers increased over time, often to a substantial extent. For example, the proportion of patients with ≥10 comorbidities increased by 23%, whereas the proportion with frailty increased by 51%. Trends were similar after adjustment for age (data not shown).
Conclusion
The complexity of nephrology inpatients is increasing over time and is not explained by population aging. The secular decrease in mortality is encouraging and warrants further investigation. These findings have implications for workforce planning, nephrology training programs and physician reimbursement policies.