Acute Kidney Failure, Uninsured, Hospital Length of Stay, Total Charges


Community Health and Preventive Medicine | Health Services Research


Objectives: To investigate the relationship between insurance status and the risk of acute kidney failure (AKF) and consequential hospitalization outcomes.

Methods: A cross-sectional regression analysis was conducted for inpatients ages 18-64 in South Carolina 2012–2013. One dichotomous dependent variable - diagnosed with AKF at hospital admission, and two continuous dependent variables of hospital outcomes - total charge and length of stay, were examined. The key explanatory variable was the patient’s insurance status. Other covariates included patient’s age, gender, and race as well as AKF risk factors - Type 2 diabetic mellitus (T2DM), chronic kidney disease (CKD), hypertension, and proteinuria.

Results: No insurance was significantly associated with an increased risk of AKF. The odds of having AKF with concurrent CKD diagnosed among the uninsured patients (OR 10.00) is about 1.5 times as high as that among Medicaid (OR 6.40) or private insurance patients (OR 6.91). Patients without insurance coverage incurred lower charges and were discharged earlier than those with Medicaid or private insurance. However, the presence of T2DM reversed this trend. Self-pay AKF patients with T2DM were charged 6% more and stayed in hospital 25% longer than similar patients with Medicaid. Likewise, their charges and hospital stay were 9% more than patients with private insurance.

Discussion: Insurance coverage could play a role in determining the risk of AKF and hospital outcomes. Insurance coverage could reduce underlying risk factors for AKF and its adverse consequences. Hospital investment to treat diabetes among the uninsured people in the catchment area might reduce uncompensated care and improve community health.