Clin Res Cardiol 96:Suppl 2 (2007)

P348 - Impact of different stages of chronic kidney disease on in-hospital costs in patients with coronary heart disease
H. Reinecke1, H. Bunzemeier2, N. Roeder2, G. Breithardt1
1Medizinische Klinik und Poliklinik C, Universitätsklinikum Münster, Münster; 2DRG-Research Group, Stabsst. Medizincontrolling, Universitätsklinikum Münster, Münster;
Introduction: Chronic kidney disease (CKD) is associated with markedly increased in-hospital morbidity and mortality. However, its effect on in-hospital costs for treatment of coronary heart disease (CHD) has not been assessed which appears to be of interest due to the exponential climb in its prevalence.
Methods: Clinical and costing data were assessed from 765 consecutive patients at our institution who suffered from CHD requiring percutaneous coronary interventions. Patient-level in-hospital costs were thoroughly calculated from precise in-house assessments for the national DRG database on which health system reimbursements are based in Germany. CKD was classified in 5 stages in accordance to the guidelines of the National Kidney Foundation.
Results: With each stage of CKD, average total in-hospital costs increased stepwise (2,926 €; 3,466 €; 4,208 €; 8,265 € and 12,530 €; respectively, p<0.0001; see Figure). In more detail, this was due to higher personal costs (p<0.001) and costs for drugs (p<0.001) but not for implants (p=0.5). Treating patients with CKD stage 4 or 5 utilized markedly more resources than patients with ST-Elevation myocardial infarction (4,916 €), coronary 3 vessel disease (4,659 €), severely impaired left ventricular function (6,072 €) or diabetes (4,495 €). Multivariate analyses by logistic regression identified the estimated glomerular filtration rate (eGFR) to be an independent predictor of in-hospital costs (p=0.006).
Conclusions: Although the absolute amount of costs may vary between different countries, this work for the first time showed that in all stages of CKD there is a significant increase of in-hospital costs treating patients with CHD.