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CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom
Dorothea Nitsch1, Bareng A S Nonyane, Liam Smeeth
1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK. dorothea.nitsch@lshtm.ac.uk
Insights
Chronic kidney disease (CKD) in older adults significantly increases hospitalization risk. Early detection of proteinuria and low estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m(2) are key indicators.
Area of Science:
- Gerontology
- Nephrology
- Public Health
Background:
- Chronic kidney disease (CKD) is linked to mortality in older adults.
- Previous research established CKD's association with cardiovascular and all-cause mortality.
- This study investigates CKD's impact on hospital admission rates in the elderly.
Purpose of the Study:
- To determine if CKD is associated with an increased rate of hospital admission in individuals aged 75 years and older.
- To identify specific markers of CKD, such as reduced estimated glomerular filtration rate (eGFR) and proteinuria, that predict hospitalization.
Main Methods:
- A cohort study involving 15,336 participants from UK general practices (1994-1999).
- eGFR and dipstick proteinuria data were analyzed for 12,371 participants.
- Hospital admissions were tracked for two years post-assessment, with adjustments for age, sex, and cardiovascular risk factors.
Main Results:
- Participants with eGFR <30 mL/min/1.73 m(2) showed a 1.66-fold increased risk of hospitalization within 6 months.
- Dipstick-positive proteinuria was consistently associated with an increased hospitalization risk (HR, 1.29).
- Both proteinuria and severely reduced eGFR (<30 mL/min/1.73 m(2)) independently predicted multiple hospital admissions over two years.
Conclusions:
- Community-dwelling older individuals with proteinuria and/or severely reduced eGFR (<30 mL/min/1.73 m(2)) face a higher risk of hospitalization.
- These findings highlight the importance of monitoring kidney function in the elderly to predict and potentially prevent hospital admissions.
- Limitations include a 2-year follow-up, potential selection bias, and single measurements.
Background:
We previously have shown that chronic kidney disease (CKD) is associated with cardiovascular and all-cause mortality in community-dwelling people 75 years and older. The present study addresses the hypothesis that CKD is associated with a higher rate of hospital admission at an older age.
Study Design:
Cohort study.
Setting & Participants:
15,336 participants from 53 UK general practices underwent comprehensive health assessment between 1994 and 1999.
Predictor:
Data for estimated glomerular filtration rate (eGFR, derived from creatinine levels using the CKD Epidemiology Collaboration [CKD-EPI] study equation) and dipstick proteinuria were available for 12,371 participants.
Outcomes:
Hospital admissions collected from hospital discharge letters for 2 years after assessment.
Measurements:
Age, sex, cardiovascular risk factors, possible biochemical and health consequences of kidney disease (hemoglobin, phosphate, and albumin levels; physical and mental health problems).
Results:
2,310 (17%) participants had 1 hospital admission, and 981 (7%) had 2 or more. After adjusting for age, sex, and cardiovascular risk factors, HRs were 1.66 (95% CI, 1.21-2.27), 1.17 (95% CI, 0.95-1.43), 1.08 (95% CI, 0.90-1.30), and 1.11 (95% CI, 0.91-1.35) for eGFRs <30, 30-44, 45-59, and ≥75 mL/min/1.73 m(2), respectively, compared with eGFRs of 60-74 mL/min/1.73 m(2) for hospitalizations during <6 months of follow-up. HRs were weaker for follow-up of 6-18 months. Dipstick-positive proteinuria was associated with an increased HR throughout follow-up (HR, 1.29 [95% CI, 1.11-1.49], adjusting for cardiovascular risk factors). Dipstick-positive proteinuria and eGFR <30 mL/min/1.73 m(2) were independently associated with 2 or more hospital admissions during the 2-year follow-up. Adjustment for other health factors and laboratory measurements attenuated the effect of eGFR, but not the effect of proteinuria.
Limitations:
Follow-up limited to 2 years, selection bias due to nonparticipation in study, missing data for potential covariates, and single noncalibrated measurements from multiple laboratories.
Conclusions:
The study indicates that community-dwelling older people who have dipstick-positive proteinuria and/or eGFR <30 mL/min/1.73 m(2) are at increased risk of hospitalization.
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