The Relationship Between Severity Of Chronic Kidney Disease And Hospitalizations In Patients With Type 2 Diabetes

Examine the associations between severity of chronic kidney disease (CKD) in patients with Type 2 diabetes, the probability of being hospitalized, and hospital length of stay (LOS). This study utilized data from Humedica electronic medical records, captured in the period January 1, 2007 through September 30, 2011. Patients eligible for this study were diagnosed with both CKD (ICD-9-CM 585.1-585.6) and Type 2 diabetes, and aged ≥21yrs as of September 30, 2011. Logistic regression analyzed the relationship between CKD severity and the probability of hospitalization, while a negative binomial regression examined the relationship between CKD severity and hospital LOS. All analyses controlled for patient demographic characteristics, baseline antidiabetic therapy, baseline HbA1c levels, patient general health, and comorbidities. 3,406 individuals met the inclusion criteria: 687 with mild (ICD-9 585.1, 585.2 ; 1,981 moderate (585.3); and 425 severe CKD (585.4, 585.5); 313 patients had end stage renal disease (ESRD) (585.6). Generally, patients with severe CKD or ESRD, compared to mild/moderate CKD, were more likely to be African-American, reside in the Midwest or South, have Medicaid insurance or be uninsured, and have received a prescription for insulin at baseline. Further, such patients were less likely to have commercial insurance, "good" glycemic control (HbA1c ≤7), or be using an oral antidiabetic therapy at baseline. Adjusted Odds Ratios (OR) showed that, compared to mild CKD, both severe CKD and ESRD were associated with a significantly higher likelihood of hospitalization in the 2 year post index date (Severe: OR=2.040, 95% CI 1.531 – 2.720; ESRD: OR=2.910, 95% CI 2.071 – 4.088). Similarly, moderate CKD, severe CKD and ESRD were associated with significantly longer LOS compared to mild CKD (Moderate: Coefficient=0.2431, P=0.0259; Severe: Coefficient=0.8081, P<0.0001; ESRD: Coefficient=1.1237, P<0.0001). As severity of CKD increases in patients with type 2 diabetes, the likelihood of hospitalization increases as does the need for inpatient resource utilization.