Factors associated with high-cost hospitalization for peritonitis in children receiving chronic peritoneal dialysis in the United States

Pediatr Nephrol. 2019 Jun;34(6):1049-1055. doi: 10.1007/s00467-018-4183-0. Epub 2019 Jan 2.


Background: Although peritonitis causes significant morbidity and mortality in children receiving chronic peritoneal dialysis (CPD), little is known about costs associated with treatment.

Methods: We analyzed 246 peritonitis-related hospitalizations in the USA, linked by the Standardized Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) and Pediatric Health Information Systems (PHIS) databases. Multivariable logistic regression was used to assess the relationship between high-cost hospitalizations (at or above the 75th percentile) and patient characteristics. Multivariable modeling was used to assess differences in the service-line specific geometric mean between (1) high- and low-cost (below the 75th percentile) hospitalizations and (2) fungal versus other types of peritonitis. Wage-adjusted hospitalization charges were converted to estimated costs using reported cost-to-charge ratios to estimate the cost of hospitalization.

Results: High-cost hospitalizations were associated with the following: age 3-12 years, Hispanic ethnicity, intensive care unit (ICU) stay, length of stay (LOS), and fungal peritonitis. Whereas absolute standardized cost by service line was significantly different when comparing high- and low-cost hospitalizations, the percentage of total cost by service line was similar in the two groups. Cost per case for fungal peritonitis was higher (p < 0.001) in every service line except pharmacy when compared to other peritonitis cases. The median (IQR) cost of hospitalization for the treatment of peritonitis was $13,655 ($7871, $28434) USD.

Conclusions: Hospitalization-related costs for peritonitis treatment are substantial and arise from a variety of service lines. Fungal peritonitis is associated with high-cost hospitalization.

Keywords: Cost-to-charge ratio; Direct cost; Pediatric peritonitis; Peritoneal dialysis-related infection; Service line; Wage-adjusted charges.

MeSH terms

  • Child
  • Child, Preschool
  • Female
  • Hospital Costs / statistics & numerical data*
  • Hospitalization / economics*
  • Humans
  • Male
  • Peritoneal Dialysis / adverse effects*
  • Peritonitis / economics*
  • Peritonitis / etiology*
  • Risk Factors
  • United States