Resource utilization among kidney transplant recipients.
BACKGROUND
Hospitalization consumes a significant portion of the end-stage renal disease (ESRD) program, which includes kidney transplant recipients. Identification of kidney transplant recipients at risk of increased resource utilization could lead to appropriate interventions to attenuate the complications related to kidney transplant, which may reduce resource utilization.


METHODS
This retrospective cohort study of kidney transplant recipients was performed to identify risk factors for hospital utilization. The study population consisted of patients who received kidney transplant at our center between October 1990 and September 1999 and were followed in the outpatient clinic.


RESULTS
Of the 220 patients, 171 (78%) were hospitalized during a median follow-up of 36 months. The number of hospitalizations, hospital days, and outpatient visits per patient-year at risk were 1.1, 6.3, and 21.6, respectively. Infection episodes were the leading cause of hospitalization. In a multivariate regression analysis, cytomegalovirus (CMV)-positive status of donor (RR 1.58; 95% CI 1.15, 2.18) and a higher number of hospital days during the transplant hospitalization (RR 1.10 per 7 days increase; 95% CI 1.03, 1.19) were associated with a higher risk of hospitalization, while higher serum albumin (RR 0.84 per 0.5 g/dL increase; 95% CI 0.73, 0.97), higher hematocrit (RR 0.95 per 1% increase; 95% CI 0.92, 0.98), higher glomerular filtration rate (GFR) (RR 0.91 per 10 mL/min/1.73 m2; 95% CI 0.85, 0.99), and an increased interval since transplant (RR 0.84 per 6 months increase; 95% CI 0.75, 0.93) were associated with a lower risk of hospitalization. CMV-positive status of the donor (RR 1.11; 95% CI 1.00, 1.21) and presence of cardiovascular disease (RR 1.12; 95% CI 1.00, 1.24) were associated with a higher risk of outpatient visits, while Caucasian race (RR 0.82; 95% CI 0.73, 0.94), higher serum albumin (RR 0.88 per 0.5 g/dL increase; 95% CI 0.84, 0.93), higher hematocrit (RR 0.96 per 1% increase; 95% CI 0.95, 0.97), and an increased interval since transplant (RR 0.79 per 6 months increase; 95% CI 0.76, 0.83) were associated with a lower risk of outpatient visits.


CONCLUSIONS
Identification of risk factors associated with increase resource utilization among kidney transplant recipients could aid in the development of targeted interventions to improve clinical and economic outcomes.
Khan
Samina
S
Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA. skhan@lifespan.org
Tighiouart
Hocine
H
Kalra
Aarti
A
Raman
Gowri
G
Rohrer
Richard J
RJ
Pereira
Brian J G
BJ
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors