Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings

Abstract Background Chronic kidney disease (CKD) typically co-exists with multimorbidity (presence of 2 or more long-term conditions: LTCs). The associations between CKD, multimorbidity and hospitalisation rates are not known. The aim of this study was to examine hospitalisation rates in people with multimorbidity with and without CKD. Amongst people with CKD, the aim was to identify risk factors for hospitalisation. Methods Two cohorts were studied in parallel: UK Biobank (a prospective research study: 2006-2020) and Secure Anonymised Information Linkage Databank (SAIL: a routine care database, Wales, UK: 2011-2018). Adults were included if their kidney function was measured at baseline. Nine categories of participants were used: zero LTCs; one, two, three and four or more LTCs excluding CKD; and one, two, three and four or more LTCs including CKD. Emergency hospitalisation events were obtained from linked hospital records. Results Amongst 469,339 UK Biobank participants, those without CKD had a median of 1 LTC and those with CKD had a median of 3 LTCs. Amongst 1,620,490 SAIL participants, those without CKD had a median of 1 LTC and those with CKD had a median of 5 LTCs. Compared to those with zero LTCs, participants with four or more LTCs (excluding CKD) had high event rates (rate ratios UK Biobank 4.95 (95% confidence interval 4.82–5.08)/SAIL 3.77 (3.71–3.82)) with higher rates if CKD was one of the LTCs (rate ratios UK Biobank 7.83 (7.42–8.25)/SAIL 9.92 (9.75–10.09)). Amongst people with CKD, risk factors for hospitalisation were advanced CKD, age over 60, multiple cardiometabolic LTCs, combined physical and mental LTCs and complex patterns of multimorbidity (LTCs in three or more body systems). Conclusions People with multimorbidity have high rates of hospitalisation. Importantly, the rates are two to three times higher when CKD is one of the multimorbid conditions. Further research is needed into the mechanism underpinning this to inform strategies to prevent hospitalisation in this very high-risk group.

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MO488HOSPITALISATION EVENTS IN PEOPLE WITH CHRONIC KIDNEY DISEASE AND MULTIPLE LONG-TERM CONDITIONS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.008 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Michael Sullivan ◽

Bhautesh Jani ◽

Alex McConnachie ◽

Frances Mair ◽

Patrick Mark

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Risk Groups ◽

Routine Care ◽

Self Report ◽

Uk Biobank ◽

Long Term Conditions ◽

Event Rates ◽

The Impact

Abstract Background and Aims: Chronic Kidney Disease (CKD) typically co-exists with multiple long-term conditions (LTCs). The impact of CKD combined with multiple LTCs on hospitalisation rates is not known. We hypothesised that hospitalisation rates would be high in people with multiple LTCs, particularly in those with CKD. We also hypothesised that the association between multiple LTCs and hospitalisation would be greatest in subgroups and with certain patterns of LTCs. Method: Two cohorts were studied in parallel: UK Biobank (2006-2019) and Secure Anonymised Information Linkage Databank (SAIL: 2011-2018, Wales, UK). UK Biobank is a prospective research cohort. SAIL is a routine care database. Participants were included if their kidney function was measured at baseline. LTCs were obtained from self-report (UK Biobank) and primary care read codes (SAIL). Participants were categorised into zero, one, two, three and four or more LTCs with and without CKD. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73m2 (single blood test for UK Biobank, two blood tests three months apart for SAIL). Hospitalisation events were obtained from linked hospital records. Results: Among 469,344 of 502,503 UK Biobank participants, those without CKD had a median age of 58 and a median of 1 LTC. Those with CKD had a median age of 64 and a median of 2 LTCs. Among 1,620,490 of 2,768,862 SAIL participants, those without CKD had a median age of 50 and a median of 1 LTC. Those with CKD had a median age of 79 and a median of 4 LTCs. Participants with four or more LTCs had high event rates (Rate Ratios (RRs) 5.35 (95% CI 5.20-5.51)/3.77 (95% CI 3.71-3.82)) with higher rates in CKD (RRs 8.99 (95% CI 8.47-9.54)/9.92 (95% CI 9.75-10.09)). Amongst those with CKD, the association between each increase in LTC count and hospitalisation was greatest in those under the age of 50 (RRs 1.93 (95% CI 1.73-2.16)/1.35(95% CI 1.29-1.41)). Event rates were highest in those with eGFR<30ml/min/1.73m2, but the impact of multiple LTCs was weaker in these participants compared to those with higher eGFRs. Event rates were high in certain patterns of LTCs: cardiometabolic LTCs (RRs 4.45 (95% CI 4.02-4.92)/2.81 (95% CI 2.71-2.91)), complex patterns (RRs 3.60 (95% CI 3.26-3.96)/2.91 (95% CI 2.81-3.01)) and physical/mental LTCs (RRs 3.30 (95% CI 2.86-3.80)/3.18 (95% CI 3.06-3.30)). Conclusion: People with multiple LTCs have high rates of hospitalisation and the rates are augmented in those with CKD. The impact of multiple LTCs is greatest in younger patients and in those with certain patterns of LTCs. Strategies should be developed to prevent hospitalisations in these high-risk groups. Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in UK Biobank Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in SAIL

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Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care

AIDS ◽

10.1097/qad.0b013e328357f5ed ◽

2012 ◽

Vol 26 (15) ◽

pp. 1907-1915 ◽

Cited By ~ 84

Author(s):

Robert C. Kalayjian ◽

Bryan Lau ◽

Rhoderick N. Mechekano ◽

Heidi M. Crane ◽

Benigno Rodriguez ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Antiretroviral Therapy ◽

Kidney Disease ◽

Routine Care ◽

Large Cohort ◽

Hiv 1

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207 FGF-23 and Cardiovascular Risk Factors in Patients with Chronic Kidney Disease: An Indian Perspective

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2018.02.213 ◽

2018 ◽

Vol 71 (4) ◽

pp. 567

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Risk Factors ◽

Fgf 23 ◽

Indian Perspective

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287 Monitoring Public Awareness, Burden, Risk Factors, and Care of Kidney Disease in the U.S.: The Centers for Disease Control and Prevention’s (CDC) Chronic Kidney Disease (CKD) Surveillance System

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2020.02.289 ◽

2020 ◽

Vol 75 (4) ◽

pp. 619

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Disease Control ◽

Surveillance System ◽

Public Awareness ◽

Centers For Disease Control ◽

The U.S

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Stroke in chronic renal failure

Orvosi Hetilap ◽

10.1556/oh.2008.28292 ◽

2008 ◽

Vol 149 (15) ◽

pp. 691-696

Author(s):

Dániel Bereczki

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Cerebrovascular Diseases ◽

Lipid Lowering ◽

Increased Risk ◽

Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

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