PLoS ONE (Jan 2023)

Admission of kidney patients to a closed staff nephrology department results in a better short-term survival.

  • Lihi Schwartz,
  • Omer Rosenshtok,
  • Leah Shalev,
  • Ella Schneider,
  • Anna Basok,
  • Marina Vorobiov,
  • Elvira Romanjuk,
  • Boris Rogachev,
  • Ismail El-Sayed,
  • Lina Schwartz,
  • Idan Menashe,
  • Ohad Regev,
  • Yosef S Haviv

DOI
https://doi.org/10.1371/journal.pone.0279172
Journal volume & issue
Vol. 18, no. 3
p. e0279172

Abstract

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BackgroundThe outcome of patients with chronic kidney disease (CKD) and acute kidney injury (AKI) is often dismal and measures to ameliorate their course are scarce. When admitted to the hospital, kidney patients are often hospitalized in general Medicine wards rather than in a specialized Nephrology department. In the current study, we compared the outcome of two cohorts of kidney patients (CKD and AKI) admitted either to general open-staff (with rotating physicians) Medicine wards or to a closed-staff (non-rotating Nephrologists) Nephrology ward.MethodsIn this population-based retrospective cohort study, we enrolled 352 CKD patients and 382 AKI patients admitted to either Nephrology or General Medicine wards. Short-term (90 days) outcomes were recorded for survival, renal outcomes, cardiovascular outcomes, and dialysis complications. Multivariate analysis was performed using logistic regression and negative binomial regression adjusting to potential sociodemographic confounders as well as to a propensity score based on the association of all medical background variables to the admitted ward, to mitigate the potential admittance bias to each ward.ResultsOne hundred and seventy-one CKD patients (48.6%) were admitted to the Nephrology ward and 181 (51.4%) were admitted to general Medicine wards. For AKI, 180 (47.1%) and 202 (52.9%) were admitted to Nephrology and general Medicine wards, respectively. Baseline age, comorbidities and the degree of renal dysfunction differed between the groups. Using propensity score analysis, a significantly reduced mortality rate was observed for kidney patients admitted to the Nephrology ward vs. general Medicine in short term mortality (but not long-term mortality) among both CKD patients admitted (OR = 0.28, CI = 0.14-0.58, p = 0.001), and AKI patients (or = 0.25, CI = 0.12-0.48, pConclusionsThus, a simple measure of admission to a specialized Nephrology department may improve kidney patient outcome, thereby potentially affecting future health care planning.