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Hospitalization Risk among Older Adults with Chronic Kidney Disease.
Am J Nephrol. 2019; 50(3):212-220.AJ

Abstract

INTRODUCTION

Chronic kidney disease (CKD) risk staging is based on estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). However, the relationship between all-cause hospitalization risk and the current CKD staging system has not been well studied among older adults, despite a high prevalence of CKD and a high risk of hospitalization in old age.

METHODS

Among 4,766 participants of the Atherosclerosis Risk in Communities study, CKD was staged according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, using creatinine-based eGFR (eGFRcr) and ACR. Incidence rates of all-cause hospitalization associated with each CKD risk group were analyzed using negative binomial regression. Additionally, cause-specific hospitalization risks for cardiovascular, infectious, kidney, and other diseases were estimated. The impacts of using cystatin C-based eGFR (eGFRcys) to estimate the prevalence of CKD and risks of hospitalization were also quantified.

RESULTS

Participants experienced 5,548 hospitalizations and 29% had CKD. Hospitalization rates per 1,000 person-years according to KDIGO risk categories were 208-223 ("low risk"), 288-376 ("moderately increased risk"), 363-548 ("high risk"), and 499-1083 ("very high risk"). The increased risk associated with low eGFR and high ACR persisted in adjusted analyses, examinations of cause-specific hospitalizations, and when CKD was staged by eGFRcys or eGFRcr-cys, a combined equation based on both creatinine and cystatin C. In comparison to eGFRcr, staging by eGFRcys increased the prevalence of CKD to 50%, but hospitalization risks remained similarly high.

DISCUSSION/CONCLUSION

In older adults, decreased eGFR, increased ACR, and KDIGO risk stages based on a combination of these measures, were strong risk factors for hospitalization. These relationships were consistent, regardless of the marker used to estimate GFR, but the use of cystatin C resulted in a substantially higher prevalence of CKD than the use of creatinine. Older adults in the population with very high risk stages of CKD have hospitalization rates exceeding 500 per 1,000 person-years.

Authors+Show Affiliations

Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, eugeniasw@unc.edu.Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31311014

Citation

Wong, Eugenia, et al. "Hospitalization Risk Among Older Adults With Chronic Kidney Disease." American Journal of Nephrology, vol. 50, no. 3, 2019, pp. 212-220.
Wong E, Ballew SH, Daya N, et al. Hospitalization Risk among Older Adults with Chronic Kidney Disease. Am J Nephrol. 2019;50(3):212-220.
Wong, E., Ballew, S. H., Daya, N., Ishigami, J., Rebholz, C. M., Matsushita, K., Grams, M. E., & Coresh, J. (2019). Hospitalization Risk among Older Adults with Chronic Kidney Disease. American Journal of Nephrology, 50(3), 212-220. https://doi.org/10.1159/000501539
Wong E, et al. Hospitalization Risk Among Older Adults With Chronic Kidney Disease. Am J Nephrol. 2019;50(3):212-220. PubMed PMID: 31311014.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospitalization Risk among Older Adults with Chronic Kidney Disease. AU - Wong,Eugenia, AU - Ballew,Shoshana H, AU - Daya,Natalie, AU - Ishigami,Junichi, AU - Rebholz,Casey M, AU - Matsushita,Kunihiro, AU - Grams,Morgan E, AU - Coresh,Josef, Y1 - 2019/07/16/ PY - 2019/04/28/received PY - 2019/06/14/accepted PY - 2019/7/17/pubmed PY - 2020/9/4/medline PY - 2019/7/17/entrez KW - Aging KW - Albuminuria KW - Chronic kidney disease KW - Estimated glomerular filtration rate KW - Hospitalization SP - 212 EP - 220 JF - American journal of nephrology JO - Am J Nephrol VL - 50 IS - 3 N2 - INTRODUCTION: Chronic kidney disease (CKD) risk staging is based on estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). However, the relationship between all-cause hospitalization risk and the current CKD staging system has not been well studied among older adults, despite a high prevalence of CKD and a high risk of hospitalization in old age. METHODS: Among 4,766 participants of the Atherosclerosis Risk in Communities study, CKD was staged according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, using creatinine-based eGFR (eGFRcr) and ACR. Incidence rates of all-cause hospitalization associated with each CKD risk group were analyzed using negative binomial regression. Additionally, cause-specific hospitalization risks for cardiovascular, infectious, kidney, and other diseases were estimated. The impacts of using cystatin C-based eGFR (eGFRcys) to estimate the prevalence of CKD and risks of hospitalization were also quantified. RESULTS: Participants experienced 5,548 hospitalizations and 29% had CKD. Hospitalization rates per 1,000 person-years according to KDIGO risk categories were 208-223 ("low risk"), 288-376 ("moderately increased risk"), 363-548 ("high risk"), and 499-1083 ("very high risk"). The increased risk associated with low eGFR and high ACR persisted in adjusted analyses, examinations of cause-specific hospitalizations, and when CKD was staged by eGFRcys or eGFRcr-cys, a combined equation based on both creatinine and cystatin C. In comparison to eGFRcr, staging by eGFRcys increased the prevalence of CKD to 50%, but hospitalization risks remained similarly high. DISCUSSION/CONCLUSION: In older adults, decreased eGFR, increased ACR, and KDIGO risk stages based on a combination of these measures, were strong risk factors for hospitalization. These relationships were consistent, regardless of the marker used to estimate GFR, but the use of cystatin C resulted in a substantially higher prevalence of CKD than the use of creatinine. Older adults in the population with very high risk stages of CKD have hospitalization rates exceeding 500 per 1,000 person-years. SN - 1421-9670 UR - https://www.unboundmedicine.com/medline/citation/31311014/Hospitalization_Risk_among_Older_Adults_with_Chronic_Kidney_Disease_ DB - PRIME DP - Unbound Medicine ER -