Health Care Utilization in Infants with ESKD

Background: In 2021 Medicare expenditures for patients with ESRD exceeded $51 billion, with inflation adjusted per-person per year (PPPY) Medicare fee for service expenditures of nearly $68,000. With recent advances in prenatal interventions and infant specific renal replacement therapy, survival of neonates with ESRD has improved over the last decade. Dialysis in neonates with ESRD is often associated with multiple comorbidities and the need for more intensified dialysis regimens. Little is known however about the impact on the health care system of improved survival in this population. Our primary aim was to investigate healthcare utilization in infants with ESRD. Methods: We conducted a retrospective review of patients with ESRD at Texas Children’s Hospital (TCH) from 2011 to 2022. We included patients ≤ 1 year of age who initiated dialysis in the Neonatal Intensive Care Unit (NICU) at TCH. We excluded patients who started dialysis prior to transfer to TCH. Data abstracted included patient demographics, initial and subsequent length of stay, comorbidities, and pediatric sub-specialist care. Data was also collected on gross charges related to the initial hospitalization, dialytic care, and gross charges following discharge up to 2 years of age. Results: 19 patients met inclusion criteria of which 68% were male, 79% had a gestational age ≥ 37 weeks, and 90% had a birth weight ≥2500 g. The most common etiology of ESRD was lower urinary tract obstruction (LUTO) followed by genetic causes. The average length of stay for the initial hospitalization was 200 days with an average of 8 sub-specialists consulted inpatient and 4.9 admissions following discharge. The average gross charge for the initial hospitalization was $2,868,980 of which 14% was associated with dialytic care. The aggregate average hospital gross charges was $946,205 from discharge up to age 2. 84% of patients were discharged on peritoneal dialysis;16% were discharged on hemodialysis. 89% of patients survived and 5% received a kidney transplant by age 2 years. Conclusion: Infant ESRD is associated with significant healthcare utilization including hospitalizations, sub-specialty care, and financial expenditures that far exceed adults with ESRD. Further investigation of healthcare utilization in this patient population can help determine the need for appropriate allocation of resources to support care delivery.