Complexity and Health Care Utilization in Infant ESKD

Key Points Infant ESKD is associated with significant health care utilization including hospitalizations, subspecialty care, and financial expenditures. Further investigation of health care utilization in infant ESKD can help guide the appropriate allocation of resources to support care delivery. Background Dialysis in neonates with ESKD is often associated with multiple comorbidities and the need for more intensified dialysis regimens. With recent advances in prenatal interventions and infant-specific KRT, survival of neonates with ESKD has improved over the past decade. Little is known, however, about the impact on the health care system of improved survival in this population. Our primary aim was to investigate health care utilization in infants with ESKD. Methods We conducted a retrospective review of infants with ESKD started on KRT during their initial neonatal admission at Texas Children's Hospital from 2011 to 2022. The primary inclusion criteria were patients who initiated chronic dialysis in the neonatal intensive care unit at Texas Children's Hospital and survival to discharge. Data abstracted included patient demographics, number of hospitalizations and length of stays, comorbidities, pediatric subspecialist care, and gross hospital charges related to the initial hospitalization, dialytic care, and care postdischarge up to the age of 2 years. Results Nineteen patients initiated dialysis in the neonatal intensive care unit and were discharged on chronic dialysis: 68% were male, 79% had a gestational age ≥37 weeks, and 90% had a birth weight ≥2500 g. The average length of stays for the initial hospitalization was 200 days (SD of 48 days) with an average of eight subspecialty consults. There were on average five admissions before age 2 years and 15 average outpatient visits per patient. The median cost of care for the initial hospitalization was $1.2 million with dialysis accounting for 16% of the total cost. The median aggregate cost of care postdischarge until age 2 years was $467,607. Conclusions Infant ESKD is associated with significant health care utilization including hospitalizations, on-going non-nephrology subspecialty care, and significant financial expenditures. Further investigation of health care utilization in this patient population can help guide the appropriate allocation of resources to support care delivery. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2025_10_30_KID0000000959.mp3