Hospitalizations among adults with chronic kidney disease in the United States: A cohort study

Abstract

Background Adults with chronic kidney disease (CKD) are hospitalized more frequently than those without CKD, but the magnitude of this excess morbidity and the factors associated with hospitalizations are not well known. Methods and findings Data from 3,939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study between 2003 and 2008 at 7 clinical centers in the United States were used to estimate primary causes of hospitalizations, hospitalization rates, and baseline participant factors associated with all-cause, cardiovascular, and non-cardiovascular hospitalizations during a median follow up of 9.6 years. Multivariable-adjusted Poisson regression was used to identify factors associated with hospitalization rates, including demographics, blood pressure, estimated glomerular filtration rate (eGFR), and proteinuria. Hospitalization rates in CRIC were compared with rates in the Nationwide Inpatient Sample (NIS) from 2012. Of the 3,939 CRIC participants, 45.1% were female, and 41.9% identified as non-Hispanic black, with a mean age of 57.7 years, and the mean eGFR is 44.9 ml/min/1.73m2. CRIC participants had an unadjusted overall hospitalization rate of 35.0 per 100 person-years (PY) [95% CI: 34.3 to 35.6] and 11.1 per 100 PY [95% CI: 10.8 to 11.5] for cardiovascular-related causes. All-cause, non-cardiovascular, and cardiovascular hospitalizations were associated with older age (≥65 versus 45 to 64 years), more proteinuria (≥150 to <500 versus <150 mg/g), higher systolic blood pressure (≥140 versus 120 to <130 mmHg), diabetes (versus no diabetes), and lower eGFR (<60 versus ≥60 ml/min/1.73m2). Non-Hispanic black (versus non-Hispanic white) race/ethnicity was associated with higher risk for cardiovascular hospitalization [rate ratio (RR) 1.25, 95% CI: 1.16 to 1.35, p-value < 0.001], while risk among females was lower [RR 0.89, 95% CI: 0.83 to 0.96, p-value = 0.002]. Rates of cardiovascular hospitalizations were higher among those with ≥500 mg/g of proteinuria irrespective of eGFR. The most common causes of hospitalization were related to cardiovascular (31.8%), genitourinary (8.7%), digestive (8.3%), endocrine, nutritional or metabolic (8.3%), and respiratory (6.7%) causes. Hospitalization rates were higher in CRIC than the NIS, except for non-cardiovascular hospitalizations among individuals aged >65 years. Limitations of the study include possible misclassification by diagnostic codes, residual confounding, and potential bias from healthy volunteer effect due to its observational nature. Conclusions In this study, we observed that adults with CKD had a higher hospitalization rate than the general population that is hospitalized, and even moderate reductions in kidney function were associated with elevated rates of hospitalization. Causes of hospitalization were predominantly related to cardiovascular disease, but other causes contributed, particularly, genitourinary, digestive, and endocrine, nutritional, and metabolic illnesses. High levels of proteinuria were observed to have the largest association with hospitalizations across a wide range of kidney function levels.

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

“…Hypertension and diabetes were the most observed comorbidities in several studies (Lee et al, 2018;Chahine, 2020). It is well known that heart failure is considered the primary diagnosis at the time of hospitalization of patients with CKD and it is most related to the end-stage (Hakopian et al, 2019;Tesfaye et al, 2019;Roux-Marson et al, 2020;Schrauben et al, 2020).…”

“…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).…”

Prevalence of hospital readmissions and related factors in patients with autoimmune diseases

“…An increase in hospitalization rates has been found in patients with chronic kidney disease, and the factor most associated with it was high levels of proteinuria [ 36 ]. AIDs can affect the kidney directly (antibodies against a renal antigen) or indirectly (with formation of immune complexes or activation of the complement system) [ 37 ].…”

Chronic kidney disease: Definition, updated epidemiology, staging, and mechanisms of increased cardiovascular risk

“…Of note, 90% of adults with CKD do not know they have it and 1 in 2 people with very low kidney function who are not on dialysis are not aware of the fact that they have CKD. 4 Diabetes and hypertension are the major causes of CKD in adults: According to the CDC, 1 in 3 adults with diabetes and 1 in 5 adults with hypertension may have CKD. According to the current CDC statistics, CKD is more common in people aged 65 years or older (38%) than in people aged 45-64 years (13%) or 18-44 years (7%), and is slightly more common in women (15%) than men (12%); moreover, African Americans are about 3 times more likely than whites to develop ESKD.…”