The Hospital Burden of Chronic Kidney Disease in Ireland: A National Analysis of Healthcare Utilisation, Mortality and Costs

Chronic kidney disease (CKD) is a growing contributor to global morbidity, mortality, and healthcare costs. Although international evidence highlights its increasing burden, the epidemiology and hospitalisation patterns of CKD in Ireland remain poorly defined, limiting opportunities for effective prevention and management. We performed a retrospective cross-sectional study of all hospital discharges in the Republic of Ireland from 2022 using the national Hospital In-Patient Enquiry (HIPE) database. Infant admissions and cases in which dialysis or kidney transplantation were the principal diagnosis were excluded. Outcomes included hospitalisation rates, length of stay (LOS), associated costs, comorbidities, and inpatient mortality. Associations between demographic and clinical characteristics and outcomes were examined using generalised linear models and multivariate logistic regression. A total of 35,409 CKD-related hospitalisations involving 24,110 patients were recorded, accounting for 422,738 bed-days and €320.3 million in expenditure. The mean LOS was 11.9 days. Males accounted for most admissions (58.9%) and costs (59.9%), while patients aged 75–84 years represented the largest share of admissions (30.0%) and expenditure (30.8%). Emergency admissions dominated (71.2%), with 69% of patients holding medical cards. After CKD, diabetic nephropathy was the most common diagnosis (49.5%), followed by tubulo-interstitial diseases (9.1%), other disorders of the kidney and ureter (6.7%) and glomerular diseases (4.3%). Principal diagnoses when CKD was an additional diagnosis included urinary system disorders (6,442 per 100,000 population), acute kidney failure (3,764 per 100,000), diabetes (Type 1: 2,540 per 100,000; Type 2: 2,489 per 100,000), heart failure (2,362 per 100,000), other sepsis (2,199 per 100,000), acute lower respiratory infections (1,831 per 100,000) and unspecified pneumonia (1,710 per 100,000). Increasing age, higher Elixhauser comorbidity scores, and the presence of acute kidney injury were independently associated with longer LOS, increased cost, and greater inpatient mortality. CKD hospitalisations impose a considerable financial and resource burden on the Irish healthcare system, particularly among older adults with multimorbidity. These findings highlight CKD as a complex multisystem condition and provide important evidence to inform health service planning. Integrating CKD management within chronic disease programmes, alongside preventive strategies and optimised inpatient care pathways, may provide opportunities to address the broader healthcare burden associated with CKD and improve patient outcomes.