Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings

Abstract

Background Chronic kidney disease (CKD) typically co-exists with multimorbidity (presence of 2 or more long-term conditions: LTCs). The associations between CKD, multimorbidity and hospitalisation rates are not known. The aim of this study was to examine hospitalisation rates in people with multimorbidity with and without CKD. Amongst people with CKD, the aim was to identify risk factors for hospitalisation. Methods Two cohorts were studied in parallel: UK Biobank (a prospective research study: 2006-2020) and Secure Anonymised Information Linkage Databank (SAIL: a routine care database, Wales, UK: 2011-2018). Adults were included if their kidney function was measured at baseline. Nine categories of participants were used: zero LTCs; one, two, three and four or more LTCs excluding CKD; and one, two, three and four or more LTCs including CKD. Emergency hospitalisation events were obtained from linked hospital records. Results Amongst 469,339 UK Biobank participants, those without CKD had a median of 1 LTC and those with CKD had a median of 3 LTCs. Amongst 1,620,490 SAIL participants, those without CKD had a median of 1 LTC and those with CKD had a median of 5 LTCs. Compared to those with zero LTCs, participants with four or more LTCs (excluding CKD) had high event rates (rate ratios UK Biobank 4.95 (95% confidence interval 4.82–5.08)/SAIL 3.77 (3.71–3.82)) with higher rates if CKD was one of the LTCs (rate ratios UK Biobank 7.83 (7.42–8.25)/SAIL 9.92 (9.75–10.09)). Amongst people with CKD, risk factors for hospitalisation were advanced CKD, age over 60, multiple cardiometabolic LTCs, combined physical and mental LTCs and complex patterns of multimorbidity (LTCs in three or more body systems). Conclusions People with multimorbidity have high rates of hospitalisation. Importantly, the rates are two to three times higher when CKD is one of the multimorbid conditions. Further research is needed into the mechanism underpinning this to inform strategies to prevent hospitalisation in this very high-risk group.

Associations between multimorbidity and adverse health outcomes in UK Biobank and the SAIL Databank: A comparison of longitudinal cohort studies

“…Strengths of UK Biobank include its size, detailed baseline assessment and measurements including biological samples, follow-up assessments for certain issues, and the availability of long-term linkage to outcome data. This has allowed investigators to explore various aspects of multimorbidity including demographic patterns [ 4 ], prevalence of disease clusters [ 8 ], association with related states such as frailty or sarcopenia [ 9 , 10 ], the impact of lifestyle factors in the context of multimorbidity [ 11 ], and associations between multimorbidity and adverse health outcomes [ 4 , 12 – 15 ]. Many such analyses would not have been possible using routine data alone, and the sample size of UK Biobank provides considerable statistical power.…”

The interplay between kidney function and multimorbidity: A scoping review

“…The most frequently studied endpoints were related to hospital care utilization. Studies looking at the outcomes of all-cause readmissions and emergency hospitalizations concluded that multimorbidity combinations including CKD consistently showed higher rates of hospital admissions across several European cohorts included in these studies 34,40 . Similar findings were observed in studies exploring potentially avoidable hospitalizations and healthcare costs as outcomes.…”

“…We identified ten studies that looked at the association between multimorbidity (including CKD) and negative health outcomes (Table 2) 22,23,[33][34][35][36][37][38][39][40] . The studies were conducted among multimorbid populations in Europe (k = 7), USA (k = 1) and Asia (k = 1).…”

Clinical use of lenvatinib in patients with previous renal and/or hepatic impairment and radioiodine‐refractory differentiated thyroid cancer

“…In one of these studies it was shown that GFR <60 ml/min/1.73 m 2 resulted in a decrease in survival from 25 to 16.4 months compared with patients with GFR ≥60 ml/min/1.73 m 2.13 On the other hand, when CKD is present in a patient, it normally coexists with a median of five other long-term comorbidities, leading to an increased risk of hospitalization of 2-3 times. 14 In turn, in patients with chronic liver disease (CLD), liver-related mortality is the leading cause of death, linked to a 1-year mortality of 1%-3.4% in early stages of cirrhosis and 20-50% in advanced stages. 15 Therefore, coexistence of cancer and CLD is a major therapeutic challenge, especially when chronic treatment with potentially hepatotoxic drugs is needed.…”

“…In one of these studies it was shown that GFR <60 ml/min/1.73 m 2 resulted in a decrease in survival from 25 to 16.4 months compared with patients with GFR ≥60 ml/min/1.73 m 2. 13 On the other hand, when CKD is present in a patient, it normally coexists with a median of five other long‐term comorbidities, leading to an increased risk of hospitalization of 2–3 times 14 …”