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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Hospitalization Risk among Older Adults with Chronic Kidney Disease
Eugenia Wong1, Shoshana H Ballew2, Natalie Daya2
1Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, eugeniasw@unc.edu.
Insights
Chronic kidney disease (CKD) staging effectively predicts hospitalization risk in older adults. Higher CKD risk stages correlate with significantly increased hospitalization rates, underscoring the importance of accurate staging for this population.
Area of Science:
- Nephrology
- Geriatrics
- Epidemiology
Background:
- Chronic kidney disease (CKD) is prevalent in older adults, a demographic also at high risk for hospitalization.
- Current CKD staging relies on estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR), but its association with hospitalization risk in the elderly is not fully understood.
Purpose of the Study:
- To evaluate the relationship between CKD risk stages and all-cause hospitalization risk in older adults.
- To compare the impact of using creatinine-based eGFR (eGFRcr) versus cystatin C-based eGFR (eGFRcys) for CKD staging and hospitalization risk assessment.
Main Methods:
- Analysis of 4,766 participants from the Atherosclerosis Risk in Communities study.
- CKD staging using Kidney Disease Improving Global Outcomes (KDIGO) criteria with eGFRcr and ACR.
- Negative binomial regression to analyze hospitalization incidence rates and cause-specific risks.
- Quantification of CKD prevalence and hospitalization risks using eGFRcys.
Main Results:
- A significant association was found between KDIGO CKD risk stages and hospitalization rates, with "very high risk" stages showing rates over 1000 per 1000 person-years.
- Increased hospitalization risk persisted across adjusted analyses, cause-specific hospitalizations, and when using eGFRcys or combined eGFRcr-cys.
- Staging with eGFRcys identified a higher CKD prevalence (50%) compared to eGFRcr, while maintaining similar high hospitalization risks.
Conclusions:
- Decreased eGFR, increased ACR, and KDIGO risk stages are strong predictors of hospitalization in older adults.
- The observed relationships were consistent regardless of the eGFR marker used, though eGFRcys indicated a higher CKD prevalence.
- Older adults with very high CKD risk stages face hospitalization rates exceeding 500 per 1000 person-years, highlighting a critical need for risk stratification.
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.
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