Chronic kidney disease and cause-specific hospitalisation: a matched cohort study using primary and secondary care patient data

Abstract

BackgroundAlthough chronic kidney disease (CKD) is associated with various outcomes, the burden of each condition for hospital admission is unknown.AimTo quantify the association between CKD and cause-specific hospitalisation.Design and settingA matched cohort study in primary care using Clinical Practice Research Datalink linked to Hospital Episode Statistics in England.MethodPatients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and a comparison group of patients without known CKD (matched for age, sex, GP, and calendar time) were identified, 2004–2014. Outcomes were hospitalisations with 10 common conditions as the primary admission diagnosis: heart failure; urinary tract infection; pneumonia; acute kidney injury (AKI); myocardial infarction; cerebral infarction; gastrointestinal bleeding; hip fracture; venous thromboembolism; and intracranial bleeding. A difference in the incidence rate of first hospitalisation for each condition was estimated between matched patients with and without CKD. Multivariable Cox regression was used to estimate a relative risk for each outcome.ResultsIn a cohort of 242 349 pairs of patients, with and without CKD, the rate difference was largest for heart failure at 6.6/1000 person-years (9.7/1000 versus 3.1/1000 person-years in patients with and without CKD, respectively), followed by urinary tract infection at 5.2, pneumonia at 4.4, and AKI at 4.1/1000 person-years. The relative risk was highest for AKI with a fully adjusted hazard ratio of 4.90, 95% confidence interval (CI) = 4.47 to 5.38, followed by heart failure with 1.66, 95% CI = 1.59 to 1.75.ConclusionHospitalisations for heart failure, infection, and AKI showed strong associations with CKD in absolute and(or) relative terms, suggesting targets for improved preventive care.

Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD

“…Third, because many of the hospitalizations were not at the hospital affiliated with the clinic at which the study was performed, we were not able to systematically examine the diagnoses prompting hospitalizations and whether or not these hospitalizations could have been prevented. Based on prior work, we know that the leading causes of hospitalization in NDD-CKD patients are cardiovascular events and infections [4,5]. Fourth, although we were able to capture admissions to acute rehabilitation units and freestanding rehabilitation hospitals, we were not able to capture admissions to skilled nursing facilities for subacute rehabilitation or long-term care.…”

“…Adults with non-dialysis-dependent chronic kidney disease (NDD-CKD) are at increased risk for hospitalization [1][2][3][4][5][6][7], and as their CKD progresses, their risk of hospitalization increases [1, 3-5, 7, 8]. Once hospitalized, patients with NDD-CKD are more likely than their non-CKD counterparts to suffer from a preventable hospital-acquired condition [9], which heightens their risk of in-hospital death, prolonged length of stay, or readmission within 90 days [10].…”

Use of vitamin D and infection in patients with chronic kidney disease

“…Infection is the leading cause of morbidity and the second cause of mortality among patients on hemodialysis (32) . A retrospective cohort study associated the increase in urinary tract infections with stages 4 and 5 of chronic kidney disease (12) . Grothe C et al demonstrated a 61% incidence of bloodstream infection, with major occurrence of gram-positive bacteria, being the most prevalent the S. aureus (56.6%) (33) .…”

“…The chronic kidney disease (CKD) is an important risk factor for the development of HAI. Urinary tract infection and pneumonia were reported with higher incidence in patients with chronic kidney diseases (11)(12) . The unfavorable clinical picture of vitamin D deficit in kidney disease favors and potentiates the occurrence of HAI.…”

High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond

“…Acute myocardial infarction (MI), which is most commonly due to atherosclerotic coronary artery disease (CAD), is still the major cause of cardiovascular mortality and morbidity worldwide (Benjamin et al, 2019). Despite our best attempts to manage CAD and its lethal sequelae with implementation of current published guidelines, patients with chronic kidney disease (CKD) continue to be disproportionately affected by cardiovascular disease compared to those without renal impairment (Culleton et al, 1999;Go et al, 2004;Iwagami et al, 2018;Matsushita et al, 2010).…”