Hospitalized patients with chronic kidney disease (CKD) are at higher risk for adverse consequences of medical care compared with those without the disease, according to a study appearing in the December 2008 issue of the Journal of the American Society Nephrology (JASN).

Hospitalized patients with chronic kidney disease (CKD) are at higher risk for adverse consequences of medical care compared with those without the disease, according to a study appearing in the December 2008 issue of the Journal of the American Society Nephrology (JASN). The findings indicate that steps should be taken to reduce potentially preventable complications of medical care for chronic kidney disease (CKD) patients, a population that is frequently under-recognized in most health care settings.

Considerable efforts have been made in recent years to reduce medical errors, and the Agency for Healthcare Research and Quality has established a number of “patient safety indicators” to monitor rates of adverse events among hospitalized patients. These patient safety indicators include complications of anesthesia, post-operative hemorrhage, transfusion reactions, infections due to medical care, and a number of other conditions. 

While chronic kidney disease (CKD) patients are likely to be at higher risk of experiencing some of these complications compared with other hospitalized patients, few studies have evaluated their risk. To investigate, Jeffrey Fink, MD, of the University of Maryland Medical System in Baltimore and his colleagues analyzed data from approximately 250,000 hospitalized patients in the Veterans’ Health Administration in 2004-2005.

The researchers found that 29% of the hospitalized veterans had chronic kidney disease (CKD), and had a higher risk of several patient safety indicators, particularly infection due to medical care and death during a hospitalization for a condition considered to be a low mortality risk. chronic kidney disease (CKD) patients also were more likely to experience complications of anesthesia, post-operative hip fracture, post-operative physiological or metabolic disturbances, and to have post-operative respiratory failure. Patients with low pre-admission glomerular filtration rates (an indicator of significant kidney damage) were at particularly high risk of experiencing a combination of patient safety indicators.

The authors concluded that their study links the presence of chronic kidney disease (CKD) with a greater risk of patient safety mishaps during hospitalization. “Further investigation is needed to examine this association in other health care systems and to define more specific safety measures, with the goal of improving patient safety in chronic kidney disease (CKD) patients,” they wrote. According to Dr. Fink, increased recognition of chronic kidney disease (CKD) and consideration of this condition when giving medical care may help to reduce the frequency of adverse safety events that occur in the health care setting.

The study was funded by National Institutes of Health Grants R21 DK075675-01 and P60 MD000532-01.

The article, entitled “The Influence of Chronic Kidney Disease on Patient Safety Among Hospitalized Veterans,” will be available online at http://jasn.asnjournals.org/ beginning on September 3, 2008 and in the December print issue of JASN.

About Chronic Kidney Disease (CKD)

The term chronic kidney disease (CKD) refers to the five stages of kidney disease – the early stages (stages 1 and 2) as well as kidney failure (stage 5). Chronic kidney disease (CKD) is a worldwide public health problem. In the US alone, 20 million adults (1 in 9) have chronic kidney disease (CKD) and another 20 million are at increased risk for developing it,. .

• Autoimmune diseases
• Systemic infections
• Urinary tract infections
• Urinary stones
• Lower urinary tract obstruction
• Neoplasia
• Family history of chronic kidney diseases
• Recovery from acute kidney failure
• Reduction in kidney mass
• Exposure to certain drugs
• Low birth weight

• Older age
• US ethnic minority status: African 
  American, American Indian, Hispanic, 
  Asian or Pacific Islander
• Exposure to certain chemical and 
  environmental conditions
• Low income/education

About Diabetes

Type 2 diabetes is also referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). Type 2 diabetes affects nearly 21 million in the United States and nearly 200 million people worldwide.

Type 2 diabetes is characterized by high levels of blood sugar, caused by the body's inability to utilize insulin to move blood sugar into the cells for energy. In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance. In many cases this actually means the pancreas produces larger than normal quantities of insulin. Diabetes is a major cause of heart disease and stroke, as well as the most common cause of blindness, kidney failure and amputations in U.S. adults.