Kidney disease increases risk of complications

By Karla Gale

NEW YORK (Reuters Health) - Chronic kidney disease puts hospitalized patients at increased risk for adverse events related to potential lapses in patient safety, according to data from the Veterans Health Administration.

Chronic kidney disease is associated with a number of conditions, such as anemia and infection, which can raise the risk of medical complications, the research team notes in the Journal of the American Society of Nephrology. Impaired kidney function also makes these patients more susceptible to toxic effects from medications.

To assess the degree of risk faced by patients with chronic kidney disease, Dr. Jeffrey C. Fink and his associates used a set of 12 patient safety indicators developed by the Agency for Healthcare Research and Quality to analyze a sample of patients admitted to Veterans Affairs hospitals for care between October 2004 and September 2005.

In the group of nearly 250,000 patients, 29 percent had chronic kidney disease. After accounting for age, gender, race, and other diseases present, Fink, at the University of Maryland School of Medicine in Baltimore, and his team found that patients with chronic kidney disease had a 19-percent greater risk of developing complications.

As for complications following surgery, patients with chronic kidney disease were up to five times more likely to experience problems than their peers with normally functioning kidneys.

During any acute hospitalization, patients with chronic kidney disease were significantly more likely to die from a condition considered to have a low mortality risk and to develop an infection as a result of medical care.

One of the most important factors affecting patient safety was failure to recognize chronic kidney disease, Fink told Reuters Health.

As the first and easiest way to improve safety for patients with chronic kidney disease, Fink recommends that "hospital systems with electronic medical records...install appropriate alerts and prompts for guideline-based care of patients with chronic kidney disease and impaired renal function."

"However, a significant portion of care for patients with chronic kidney disease is outside of organized medical systems," such as in doctors' offices, ER's and pharmacies. "In these settings more novel alert strategies are needed," he said.

SOURCE: Journal of the American Society of Nephrology, September 3rd online 2008.