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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Chronic kidney disease and cause-specific hospitalisation: a matched cohort study using primary and secondary care
Masao Iwagami1, Ben Caplin2, Liam Smeeth1
1Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London.
Insights
Chronic kidney disease (CKD) significantly increases hospital admissions for heart failure, infections like urinary tract infections and pneumonia, and acute kidney injury (AKI). These findings highlight key areas for enhanced preventive care in CKD patients.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Chronic kidney disease (CKD) is linked to various adverse outcomes.
- The specific burden of CKD on hospital admissions for different conditions remains unclear.
Purpose of the Study:
- To quantify the association between CKD and cause-specific hospitalizations.
- To identify the primary conditions contributing to hospital admission in CKD patients.
Main Methods:
- A matched cohort study utilized UK primary care data (CPRD) linked to hospital records (HES).
- Patients with CKD (eGFR <60 mL/min/1.73 m² for ≥3 months) were compared to matched controls without CKD.
- Hospitalizations for 10 common conditions were analyzed using Cox regression to estimate relative risks.
Main Results:
- The largest absolute differences in hospitalization rates were observed for heart failure (6.6/1000 person-years), urinary tract infection (5.2), pneumonia (4.4), and acute kidney injury (AKI) (4.1).
- Relative risk was highest for AKI (HR 4.90) and heart failure (HR 1.66) in patients with CKD compared to controls.
- A cohort of 242,349 matched pairs was analyzed.
Conclusions:
- Hospitalizations for heart failure, infections, and AKI demonstrate strong associations with CKD.
- These findings suggest critical targets for improving preventive strategies and patient care in individuals with CKD.
Background:
Although chronic kidney disease (CKD) is associated with various outcomes, the burden of each condition for hospital admission is unknown.
Aim:
To quantify the association between CKD and cause-specific hospitalisation.
Design And Setting:
A matched cohort study in primary care using Clinical Practice Research Datalink linked to Hospital Episode Statistics in England.
Method:
Patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and a comparison group of patients without known CKD (matched for age, sex, GP, and calendar time) were identified, 2004-2014. Outcomes were hospitalisations with 10 common conditions as the primary admission diagnosis: heart failure; urinary tract infection; pneumonia; acute kidney injury (AKI); myocardial infarction; cerebral infarction; gastrointestinal bleeding; hip fracture; venous thromboembolism; and intracranial bleeding. A difference in the incidence rate of first hospitalisation for each condition was estimated between matched patients with and without CKD. Multivariable Cox regression was used to estimate a relative risk for each outcome.
Results:
In a cohort of 242 349 pairs of patients, with and without CKD, the rate difference was largest for heart failure at 6.6/1000 person-years (9.7/1000 versus 3.1/1000 person-years in patients with and without CKD, respectively), followed by urinary tract infection at 5.2, pneumonia at 4.4, and AKI at 4.1/1000 person-years. The relative risk was highest for AKI with a fully adjusted hazard ratio of 4.90, 95% confidence interval (CI) = 4.47 to 5.38, followed by heart failure with 1.66, 95% CI = 1.59 to 1.75.
Conclusion:
Hospitalisations for heart failure, infection, and AKI showed strong associations with CKD in absolute and(or) relative terms, suggesting targets for improved preventive care.
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