Hospitalization Risk among Older Adults with Chronic Kidney Disease

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.

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].…”

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

“…Indeed, it is widely known that kidney disease is one of the most comorbid conditions in older adults, with an overall estimated prevalence ranging from 21.4 to 47.0% and with an incidence rate of stage G4 that rises with older age (Matsushita et al, 2010;Amaral et al, 2019;Ravani et al, 2020). Aging with multimorbidity and polytherapy are the most significant factors associated with the onset and progression of end-stages of CKD but also with the hospitalization rate (Mallappallil et al, 2014;Wong et al, 2019;Schrauben et al, 2020). Moreover, the presence of CKD could be associated with several comorbidities, including hypertension, diabetes, chronic respiratory and cardiovascular disorders (Fox et al, 2012;Mahmoodi et al, 2014;Fraser et al, 2015).…”

Chronic and End-Stage Kidney Disease in the Neurological Intensive Care Unit

“…1 Patients with CKD are more likely to be hospitalized and require intensive care compared to patients with normal renal function. 2 CKD also causes numerous physiological changes that increase the risk of neurological disease and complicate the management and outcome of neurological patients during admission and long after discharge. 3 Given these brain-kidney interactions, it is important for practitioners who care for patients with brain injury to understand how CKD interacts with acute neurological injury to optimize care for these complex patients.…”