Reasons for Hospitalization among Patients with Advanced Chronic Kidney Disease: Experience from a Tertiary Care Hospital

Abstract Introduction: Patients with chronic kidney disease (CKD) are most burdened by recurrent hospitalizations. We planned this study to identify the reasons for hospitalization among patients with CKD. Materials and Methods: This was a hospital-based cross-sectional observational study of patients with CKD at any stage, per the KIDGCO criteria, aged >18 years, and admitted for >24 h. Patients with acute kidney injury, those admitted for routine hemodialysis, renal biopsy, or AV fistula creation, and those who died or were discharged within 24 h were excluded. All patients underwent clinical evaluation for any precipitating illness. Complete hemogram, renal parameters, electrolytes, electrocardiogram, chest X-ray, abdominal ultrasound, blood gas analysis, and urinalysis were performed in all patients. Results: We included 227 patients (162 males and 65 females) with a mean age of 55.2 ± 13.9 years. Eighty-five (37.4%) patients were on regular maintenance dialysis, and 117 (51.5%) were in CKD stage V and not on regular dialysis. Urinary tract infections were the most common, affecting 46 (20.2%) patients, followed by respiratory infections 26 (11.4%), skin and soft tissue infections 16 (7.0%), and tropical infections 35 (15.4%). Uremic symptoms were present in 120 (52.8%) patients, fluid overload in 60 (26.4%), accelerated hypertension in 25 (11%), and hyperkalemia in 60 (26.4%). 64.3% of patients had previous hospitalization for CKD-related complications, and 21.1% had a history of multiple (>2) hospital admissions. Conclusion: As uremia and infections are the main reasons for hospitalization in our setting, early diagnosis and treatment of infections in an outdoor setting, proper care of the catheter site, education of the patient and caregivers regarding the need for regular and adequate dialysis, and immunization may reduce the need for hospitalization.