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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease
Rasheeda K Hall1,2,3, Hui Zhou4, Kristi Reynolds4
1Durham Veterans Affairs Medical Center Healthcare System, Renal Section, Durham, NC.
Insights
A new CKD-Discordance Index helps identify older adults with chronic kidney disease (CKD) and complex conditions. This index predicts higher risks of hospitalization, emergency visits, and mortality in this vulnerable population.
Area of Science:
- Gerontology
- Nephrology
- Health Services Research
Background:
- Older adults with chronic kidney disease (CKD) and discordant conditions face increased risks.
- Discordant conditions complicate CKD management, leading to higher hospitalization and mortality rates.
- Electronic health records (EHRs) offer a potential data source for identifying these risks.
Purpose of the Study:
- To develop a novel CKD-Discordance Index.
- To utilize EHR data for recognizing discordance in older adults with CKD.
- To improve risk stratification for hospitalization and mortality.
Main Methods:
- Retrospective cohort study of 30,932 older adults with incident CKD.
- Developed a prediction model for 1-year hospitalization risk using Cox regression.
- Calculated the CKD-Discordance Index based on weighted conditions and assessed its association with healthcare utilization and mortality.
Main Results:
- The CKD-Discordance Index incorporated conditions like heart failure, dementia, and cancer.
- Higher index scores correlated with increased risk of hospitalization (HR 1.81 for highest quartile).
- A graded association was observed between the index and emergency department visits and mortality.
Conclusions:
- A data-driven approach successfully identified indicators for the CKD-Discordance Index.
- The developed index effectively predicts healthcare utilization and mortality in older adults with CKD.
- This tool can aid in recognizing and managing complex patient profiles in CKD care.
Background:
Older adults with chronic kidney disease (CKD)-discordant conditions (comorbid conditions with treatment recommendations that potentially complicate CKD management) have higher risk of hospitalization and death. Our goal is to develop a CKD-Discordance Index using electronic health records to improve recognition of discordance.
Methods:
This retrospective cohort study included Kaiser Permanente Southern California patients aged ≥65 years and older with incident CKD (N = 30,932). To guide inclusion of conditions in the Index and weight each condition, we first developed a prediction model for 1-year hospitalization risk using Cox regression. Points were assigned proportional to regression coefficients derived from the model. Next, the CKD-Discordance Index was calculated as an individual's total points divided by the maximum possible discordance points. The association between CKD-Discordance Index and hospitalizations, emergency department visits, and mortality was accessed using multivariable-adjusted Cox regression model.
Results:
Overall, mean (SD) age was 77.9 (7.6) years, 55% of participants were female, 59.3% were white, and 32% (n = 9,869) had ≥1 hospitalization during 1 year of follow-up. The CKD-Discordance Index included the following variables: heart failure, gastroesophageal reflux disease/peptic ulcer disease, osteoarthritis, dementia, depression, cancer, chronic obstructive pulmonary disease/asthma, and having four or more prescribers. Compared to those with a CKD-Discordance Index of 0, adjusted hazard ratios (95% confidence interval) for hospitalization were 1.39 (1.27-1.51) and 1.81 (1.64-2.01) for those with a CKD-Discordance Index of 0.001-0.24 and ≥0.25, respectively (ptrend < .001). A graded pattern of risk was seen for emergency department visits and all-cause mortality.
Conclusion:
A data-driven approach identified CKD-discordant indicators for a CKD-Discordance Index. Higher CKD-Discordance Index was associated with health care utilization and mortality.
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