Trends in pediatric primary membranoproliferative glomerulonephritis costs and complications

Abstract

Background: Data on pediatric membranoproliferative glomerulonephritis (MPGN) epidemiology, complications, and healthcare costs are critical to our understanding of MPGN's economic burden and of how best to direct clinical care and research efforts in the future.

Methods: We analyzed 10-year trends in epidemiology, complications, and hospital charges for pediatric primary MPGN hospitalizations using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) for 1997-2006. We identified approximately 320 primary MPGN admissions per year, corresponding to approximately 4.3 % of all glomerular disease admissions.

Results: Older children were at higher risk for admission (odds ratios for ages 6-10, 11-15, and 16-18 years were 7.5, 9.3, and 4.7, respectively compared to 0-5 years; p < 0.0001). Gender, race, income, hospital location, and admission season were not significant risk factors. The incidence of MPGN admission-associated acute renal failure (ARF) increased to >147 % (from <3 to 7.4 %) over time, while admission-associated renal biopsy (approx. 34.8 %), renal replacement therapy (approx. 18.4 %), and transplantation (approx. 5 %) remained constant. Hospital length of stay (LOS) increased by 68 % (from 5.0 to 8.4 days), whereas mean total hospital charges increased by 213 % (from $13,718 to $42,891), concomitant with a strong trend from private toward public health insurance.

Conclusions: We conclude that while the incidence of pediatric primary MPGN hospitalizations has remained stable over the last 10 years, they have been associated with marked increases in the frequency of ARF, as well as dramatically increased hospital LOS and charges.