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Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD

INTRODUCTION: Management of chronic kidney disease (CKD) entails high medical complexity and often results in high hospitalization burden. There are limited data on the associations of longitudinal hospital utilization patterns with adverse clinical outcomes in individuals with CKD. METHODS: We deri...

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Autores principales: Srivastava, Anand, Cai, Xuan, Mehta, Rupal, Lee, Jungwha, Chu, David I., Mills, Katherine T., Shafi, Tariq, Taliercio, Jonathan J., Hsu, Jesse Y., Schrauben, Sarah J., Saunders, Milda R., Diamantidis, Clarissa J., Hsu, Chi-yuan, Waikar, Sushrut S., Lash, James P., Isakova, Tamara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207467/
https://www.ncbi.nlm.nih.gov/pubmed/34169199
http://dx.doi.org/10.1016/j.ekir.2021.03.883
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author Srivastava, Anand
Cai, Xuan
Mehta, Rupal
Lee, Jungwha
Chu, David I.
Mills, Katherine T.
Shafi, Tariq
Taliercio, Jonathan J.
Hsu, Jesse Y.
Schrauben, Sarah J.
Saunders, Milda R.
Diamantidis, Clarissa J.
Hsu, Chi-yuan
Waikar, Sushrut S.
Lash, James P.
Isakova, Tamara
author_facet Srivastava, Anand
Cai, Xuan
Mehta, Rupal
Lee, Jungwha
Chu, David I.
Mills, Katherine T.
Shafi, Tariq
Taliercio, Jonathan J.
Hsu, Jesse Y.
Schrauben, Sarah J.
Saunders, Milda R.
Diamantidis, Clarissa J.
Hsu, Chi-yuan
Waikar, Sushrut S.
Lash, James P.
Isakova, Tamara
author_sort Srivastava, Anand
collection PubMed
description INTRODUCTION: Management of chronic kidney disease (CKD) entails high medical complexity and often results in high hospitalization burden. There are limited data on the associations of longitudinal hospital utilization patterns with adverse clinical outcomes in individuals with CKD. METHODS: We derived cumulative all-cause hospitalization trajectory groups using latent class trajectory analysis in 3012 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study who were alive and did not reach end-stage kidney disease (ESKD) within 4 years of study entry. Cox proportional hazards models tested the associations between hospitalization trajectory groups and risks of ESKD and death prior to the onset of ESKD (ESKD-censored death). RESULTS: Within 4 years of study entry, there were 5658 hospitalizations among 3012 participants. We identified 3 distinct subgroups of individuals with CKD based on cumulative all-cause hospitalization trajectories over 4 years: low-utilizer (n = 1066), intermediate-utilizer (n = 1802), and high-utilizer (n = 144). High-utilizers represented a patient population of lower socioeconomic status who had a greater prevalence of comorbid conditions and lower kidney function compared with intermediate- and low-utilizers. After the 4-year ascertainment period to form the trajectory subgroups, there were 544 ESKD events and 437 ESKD-censored deaths during a median follow-up time of 5.1 years. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.49-fold (95% confidence interval [CI] 1.22–1.84) and 1.75-fold (95% CI 1.20–2.56) higher risk of ESKD in adjusted analyses, respectively. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.48-fold (95% CI 1.17–1.87) and 2.58-fold (95% CI 1.74–3.83) higher risk of ESKD-censored death in adjusted analyses, respectively. CONCLUSIONS: Trajectories of cumulative all-cause hospitalization identify subgroups of individuals with CKD who are at high risk of ESKD and death.
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spelling pubmed-82074672021-06-23 Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD Srivastava, Anand Cai, Xuan Mehta, Rupal Lee, Jungwha Chu, David I. Mills, Katherine T. Shafi, Tariq Taliercio, Jonathan J. Hsu, Jesse Y. Schrauben, Sarah J. Saunders, Milda R. Diamantidis, Clarissa J. Hsu, Chi-yuan Waikar, Sushrut S. Lash, James P. Isakova, Tamara Kidney Int Rep Clinical Research INTRODUCTION: Management of chronic kidney disease (CKD) entails high medical complexity and often results in high hospitalization burden. There are limited data on the associations of longitudinal hospital utilization patterns with adverse clinical outcomes in individuals with CKD. METHODS: We derived cumulative all-cause hospitalization trajectory groups using latent class trajectory analysis in 3012 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study who were alive and did not reach end-stage kidney disease (ESKD) within 4 years of study entry. Cox proportional hazards models tested the associations between hospitalization trajectory groups and risks of ESKD and death prior to the onset of ESKD (ESKD-censored death). RESULTS: Within 4 years of study entry, there were 5658 hospitalizations among 3012 participants. We identified 3 distinct subgroups of individuals with CKD based on cumulative all-cause hospitalization trajectories over 4 years: low-utilizer (n = 1066), intermediate-utilizer (n = 1802), and high-utilizer (n = 144). High-utilizers represented a patient population of lower socioeconomic status who had a greater prevalence of comorbid conditions and lower kidney function compared with intermediate- and low-utilizers. After the 4-year ascertainment period to form the trajectory subgroups, there were 544 ESKD events and 437 ESKD-censored deaths during a median follow-up time of 5.1 years. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.49-fold (95% confidence interval [CI] 1.22–1.84) and 1.75-fold (95% CI 1.20–2.56) higher risk of ESKD in adjusted analyses, respectively. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.48-fold (95% CI 1.17–1.87) and 2.58-fold (95% CI 1.74–3.83) higher risk of ESKD-censored death in adjusted analyses, respectively. CONCLUSIONS: Trajectories of cumulative all-cause hospitalization identify subgroups of individuals with CKD who are at high risk of ESKD and death. Elsevier 2021-03-31 /pmc/articles/PMC8207467/ /pubmed/34169199 http://dx.doi.org/10.1016/j.ekir.2021.03.883 Text en © 2021 International Society of Nephrology. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Srivastava, Anand
Cai, Xuan
Mehta, Rupal
Lee, Jungwha
Chu, David I.
Mills, Katherine T.
Shafi, Tariq
Taliercio, Jonathan J.
Hsu, Jesse Y.
Schrauben, Sarah J.
Saunders, Milda R.
Diamantidis, Clarissa J.
Hsu, Chi-yuan
Waikar, Sushrut S.
Lash, James P.
Isakova, Tamara
Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD
title Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD
title_full Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD
title_fullStr Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD
title_full_unstemmed Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD
title_short Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD
title_sort hospitalization trajectories and risks of eskd and death in individuals with ckd
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207467/
https://www.ncbi.nlm.nih.gov/pubmed/34169199
http://dx.doi.org/10.1016/j.ekir.2021.03.883
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