Yan Xie1, Benjamin Bowe1, Hong Xian2, Sumitra Balasubramanian1, Ziyad Al-Aly3. 1. Clinical Epidemiology Center and. 2. Clinical Epidemiology Center and Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri; and. 3. Clinical Epidemiology Center and Division of Nephrology, Department of Medicine, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri; Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri zalaly@gmail.com.
Abstract
BACKGROUND AND OBJECTIVES: Risk of hospitalizations is increased in patients with CKD. We sought to examine the association between rate of kidney function decline and risk of hospitalization in a cohort of patients with early CKD. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: We built a cohort of 247,888 United States veterans who had at least one eGFR measurement between October 1999 and September 2003 and an additional eGFR between October 2003 and September 2004. We selected patients whose initial eGFR was between 45 and 59 ml/min per 1.73 m2. Rate of eGFR change (in milliliters per minute per 1.73 m2 per year) was categorized as no decline (>0), mild (0 to -1, and served as the referent group), moderate (-1 to -5), or severe (>-5) eGFR decline. We built survival models to examine the association between the rate of kidney function decline and the risk of hospitalization and readmission and linear regression to estimate length of hospital stay. RESULTS: Over a median observation of 9 years (interquartile range, 5.28-9.00), patients with moderate and severe eGFR decline exhibited a higher risk of hospitalizations (hazard ratio [HR], 1.22; 95% confidence interval [95% CI], 1.19 to 1.26; and HR, 1.33; 95% CI, 1.28 to 1.39, respectively). Among patients with moderate and severe eGFR decline, the association between the rate of decline and the risk of hospitalizations was more pronounced with an increased number of hospitalizations (P<0.01). Patients with moderate and severe eGFR decline had a higher risk of readmission (HR, 1.19; 95% CI, 1.13 to 1.26; and HR, 1.53; 95% CI, 1.43 to 1.63, respectively). Among patients with severe eGFR decline, the association between the rate of kidney function decline and the risk of readmission was stronger with an increased number of readmissions (P<0.01). Patients with moderate and severe eGFR decline experienced an additional length of stay of 1.40 (95% CI, 0.88 to 1.92) and 5.00 days per year (95% CI, 4.34 to 5.66), respectively. CONCLUSIONS: The rate of kidney function decline is associated with a higher risk of hospitalizations, readmissions, and prolonged length of hospital stay.
BACKGROUND AND OBJECTIVES: Risk of hospitalizations is increased in patients with CKD. We sought to examine the association between rate of kidney function decline and risk of hospitalization in a cohort of patients with early CKD. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: We built a cohort of 247,888 United States veterans who had at least one eGFR measurement between October 1999 and September 2003 and an additional eGFR between October 2003 and September 2004. We selected patients whose initial eGFR was between 45 and 59 ml/min per 1.73 m2. Rate of eGFR change (in milliliters per minute per 1.73 m2 per year) was categorized as no decline (>0), mild (0 to -1, and served as the referent group), moderate (-1 to -5), or severe (>-5) eGFR decline. We built survival models to examine the association between the rate of kidney function decline and the risk of hospitalization and readmission and linear regression to estimate length of hospital stay. RESULTS: Over a median observation of 9 years (interquartile range, 5.28-9.00), patients with moderate and severe eGFR decline exhibited a higher risk of hospitalizations (hazard ratio [HR], 1.22; 95% confidence interval [95% CI], 1.19 to 1.26; and HR, 1.33; 95% CI, 1.28 to 1.39, respectively). Among patients with moderate and severe eGFR decline, the association between the rate of decline and the risk of hospitalizations was more pronounced with an increased number of hospitalizations (P<0.01). Patients with moderate and severe eGFR decline had a higher risk of readmission (HR, 1.19; 95% CI, 1.13 to 1.26; and HR, 1.53; 95% CI, 1.43 to 1.63, respectively). Among patients with severe eGFR decline, the association between the rate of kidney function decline and the risk of readmission was stronger with an increased number of readmissions (P<0.01). Patients with moderate and severe eGFR decline experienced an additional length of stay of 1.40 (95% CI, 0.88 to 1.92) and 5.00 days per year (95% CI, 4.34 to 5.66), respectively. CONCLUSIONS: The rate of kidney function decline is associated with a higher risk of hospitalizations, readmissions, and prolonged length of hospital stay.
Authors: Ann M O'Hare; Adam Batten; Nilka Ríos Burrows; Meda E Pavkov; Leslie Taylor; Indra Gupta; Jeff Todd-Stenberg; Charles Maynard; Rudolph A Rodriguez; Fliss E M Murtagh; Eric B Larson; Desmond E Williams Journal: Am J Kidney Dis Date: 2012-02-04 Impact factor: 8.860
Authors: Liang Li; Brad C Astor; Julia Lewis; Bo Hu; Lawrence J Appel; Michael S Lipkowitz; Robert D Toto; Xuelei Wang; Jackson T Wright; Tom H Greene Journal: Am J Kidney Dis Date: 2012-01-26 Impact factor: 8.860
Authors: Robert M Perkins; Ion D Bucaloiu; H Lester Kirchner; Nasrin Ashouian; James E Hartle; Taher Yahya Journal: Clin J Am Soc Nephrol Date: 2011-06-16 Impact factor: 8.237
Authors: Tanvir Chowdhury Turin; Josef Coresh; Marcello Tonelli; Paul E Stevens; Paul E de Jong; Christopher K T Farmer; Kunihiro Matsushita; Brenda R Hemmelgarn Journal: Am J Nephrol Date: 2012-06-14 Impact factor: 3.754
Authors: Matthew T James; Hude Quan; Marcello Tonelli; Braden J Manns; Peter Faris; Kevin B Laupland; Brenda R Hemmelgarn Journal: Am J Kidney Dis Date: 2009-05-17 Impact factor: 8.860
Authors: Roberto Minutolo; Alessio Aghemo; Antonio Chirianni; Fabrizio Fabrizi; Loreto Gesualdo; Edoardo G Giannini; Paolo Maggi; Vincenzo Montinaro; Ernesto Paoletti; Marcello Persico; Francesco Perticone; Salvatore Petta; Massimo Puoti; Giovanni Raimondo; Maria Rendina; Anna Linda Zignego Journal: Intern Emerg Med Date: 2018-09-25 Impact factor: 3.397
Authors: Esteban A Cedillo-Couvert; Jesse Y Hsu; Ana C Ricardo; Michael J Fischer; Ben S Gerber; Edward J Horwitz; John W Kusek; Eva Lustigova; Amada Renteria; Sylvia E Rosas; Milda Saunders; Daohang Sha; Anne Slaven; James P Lash Journal: Clin J Am Soc Nephrol Date: 2018-10-18 Impact factor: 8.237
Authors: Benjamin Bowe; Yan Xie; Hong Xian; Sumitra Balasubramanian; Mohamed A Zayed; Ziyad Al-Aly Journal: Clin J Am Soc Nephrol Date: 2016-08-11 Impact factor: 8.237
Authors: Benjamin Bowe; Miao Cai; Yan Xie; Andrew K Gibson; Geetha Maddukuri; Ziyad Al-Aly Journal: Clin J Am Soc Nephrol Date: 2020-11-16 Impact factor: 8.237