Additional burden of intensive care to rehospitalizations following kidney transplantation. A study of rate, causes, and risk factors

ABSTRACT

Little information exists on the burden of intensive care unit [ICU] to the posttransplant rehospitalizations of kidney allograft recipients. We do not clearly know the extent of the need for ICU during rehospitalizations and causes of readmissions. In this study, we aimed to assess ICU admissions of kidney transplant recipients, to determine the risk factors of ICU admissions in rehospitalized patients, and to evaluate the additional burden of ICU admission. A total of 581 posttransplant rehospitalizations of kidney transplant recipients were assessed for ICU admission. Clinical characteristics of the patients and the length of hospital stay, transplantation-admission interval, hospitalization costs, and mortality rate were reviewed. Twenty-five rehospitalized kidney transplant recipients [4.3%] had been admitted to ICU with kidney dysfunction [36.0%], cerebrovascular accident [24.0%], sepsis [16.0%], brain tumor [8.0%], brain abscess [4.0%], diabetic ketoacidosis [4.0%], trauma [4.0%], and hemodynamic shock [4.0%]. The risk factors of referral to ICU were higher age [P = .001] and hospitalization for cerebrovascular accident [P = .001] and malignancy [P = .004]. Additional burdens were 1.8, 3.3, and 11.4 times as high as the rehospitalization burden for the length of hospital stay, hospitalization costs, and mortality rate, respectively. Age and some special causes of hospitalizations are risk factors of ICU admission of kidney transplant recipients, and this occurs in about 5% of rehospitalizations. Admission to ICU adds considerably to the burden of rehospitalizations, warranting measures to prevent conditions that lead to the need for intensive care in these patients