Hospitalized patients with chronic kidney disease (CKD) are at higher risk for adverse consequences of medical care compared with those without the disease, according to a study appearing in the December 2008 issue of the Journal of the American Society Nephrology (JASN). The findings indicate that steps should be taken to reduce potentially preventable complications of medical care for CKD patients, a population that is frequently under-recognized in most health care settings.
Considerable efforts have been made in recent years to reduce medical errors, and the Agency for Healthcare Research and Quality has established a number of "patient safety indicators" to monitor rates of adverse events among hospitalized patients. These patient safety indicators include complications of anesthesia, post-operative hemorrhage, transfusion reactions, infections due to medical care, and a number of other conditions.
While CKD patients are likely to be at higher risk of experiencing some of these complications compared with other hospitalized patients, few studies have evaluated their risk. To investigate, Jeffrey Fink, MD, of the University of Maryland Medical System in Baltimore and his colleagues analyzed data from approximately 250,000 hospitalized patients in the Veterans' Health Administration in 2004-2005.
The researchers found that 29% of the hospitalized veterans had CKD, and had a higher risk of several patient safety indicators, particularly infection due to medical care and death during a hospitalization for a condition considered to be a low mortality risk. CKD patients also were more likely to experience complications of anesthesia, post-operative hip fracture, post-operative physiological or metabolic disturbances, and to have post-operative respiratory failure. Patients with low pre-admission glomerular filtration rates (an indicator of significant kidney damage) were at particularly high risk of experiencing a combination of patient safety indicators.
The authors concluded that their study links the presence of CKD with a greater risk of patient safety mishaps during hospitalization. "Further investigation is needed to examine this association in other health care systems and to define more specific safety measures, with the goal of improving patient safety in CKD patients," they wrote. According to Dr. Fink, increased recognition of CKD and consideration of this condition when giving medical care may help to reduce the frequency of adverse safety events that occur in the health care setting.
The study was funded by National Institutes of Health Grants R21 DK075675-01 and P60 MD000532-01.
The article, entitled "The Influence of Chronic Kidney Disease on Patient Safety Among Hospitalized Veterans," will be available online at http://jasn.asnjournals.org/ beginning on September 3, 2008 and in the December print issue of JASN.
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