Healthcare Utilization in Chronic Kidney Disease

Healthcare utilisation in chronic kidney disease (CKD) encompasses a spectrum of services including routine outpatient monitoring, emergency department attendances, hospital admissions, dialysis sessions and ancillary support such as rehabilitation or home‐based therapies. Patients with CKD experience disproportionately high rates of healthcare encounters driven by cardiovascular complications, infections, fluid overload and anaemia. Even modest declines in kidney function confer elevated risks of both all‐cause and cause‐specific hospital admissions, with cardiovascular disease accounting for a substantial fraction of inpatient episodes. Dialysis-dependent patients represent a particularly resource‐intensive subgroup, exhibiting frequent visits to emergency services, pronounced peaks in utilisation following the long interdialytic interval and considerable readmission rates within 30 days of discharge. The economic burden of CKD spans direct costs of renal replacement therapy, inpatient care and post‐discharge support, as well as indirect costs related to loss of productivity and comorbidity management. Globally, variations in access to specialist nephrology care, disparities in referral patterns and differences in payment models influence both the frequency and quality of service delivery. Optimising utilisation requires early risk stratification, integration of preventive strategies to reduce avoidable admissions, multidisciplinary care pathways and value‐based approaches that align patient outcomes with system costs. Emerging digital health programmes and telemedicine initiatives hold promise for enhancing surveillance of renal function, reducing travel-related barriers and mitigating acute decompensations through timely intervention.

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Healthcare Utilization in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in healthcare utilization in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Estimated glomerular filtration rate (eGFR): A calculated measure of renal filtration capacity based on serum creatinine, age, sex and race, used to stage CKD.

Proteinuria: The presence of excess protein in the urine, an indicator of renal damage and a predictor of disease progression and complications.

Interdialytic interval: The time period between successive haemodialysis sessions, typically longest over the weekend for patients on thrice-weekly schedules.

Renal replacement therapy (RRT): Treatments that substitute or support kidney function, including haemodialysis, peritoneal dialysis and kidney transplantation.

References

1. Hospitalizations among adults with chronic kidney disease in the United States: A cohort study. PLOS Medicine (2020).
2. Chronic kidney disease and cause-specific hospitalisation: a matched cohort study using primary and secondary care patient data. British Journal of General Practice (2018).
3. Patterns of emergency department utilization by patients on chronic dialysis: A population-based study. PLOS ONE (2018).
4. Potentially Avoidable Readmissions in United States Hemodialysis Patients. Kidney International Reports (2017).
5. Association of Specialist Physician Payment Model With Visit Frequency, Quality, and Costs of Care for People With Chronic Disease. JAMA Network Open (2019).
6. Emergency department visits and hospitalizations among hemodialysis patients by day of the week and dialysis schedule in the United States. PLOS ONE (2019).
7. Assessing value‐based health care delivery for haemodialysis. Journal of Evaluation in Clinical Practice (2015).