CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom
Nitsch , Dorothea, Nonyane, Bareng A.S., Smeeth, Liam, Bulpitt, Christopher J., Roderick, Paul J. and Fletcher, Astrid (2011) CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom. American Journal of Kidney Diseases, 57, (5), 664-672. (doi:10.1053/j.ajkd.2010.09.026). (PMID:21146270).
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Background: we previously have shown that chronic kidney disease (CKD) is associated with cardiovascular
and all-cause mortality in community-dwelling people 75 years and older. The present study addresses the
hypothesis that CKD is associated with a higher rate of hospital admission at an older age.
Study Design: cohort study.
Setting & Participants: 15,336 participants from 53 UK general practices underwent comprehensive health
assessment between 1994 and 1999.
Predictor: data for estimated glomerular filtration rate (eGFR, derived from creatinine levels using the CKD
Epidemiology Collaboration [CKD-EPI] study equation) and dipstick proteinuria were available for 12,371
Outcomes: hospital admissions collected from hospital discharge letters for 2 years after assessment.
Measurements: Age, sex, cardiovascular risk factors, possible biochemical and health consequences of
kidney disease (hemoglobin, phosphate, and albumin levels; physical and mental health problems).
Results: 2,310 (17%) participants had 1 hospital admission, and 981 (7%) had 2 or more. After adjusting for
age, sex, and cardiovascular risk factors, HRs were 1.66 (95% CI, 1.21-2.27), 1.17 (95% CI, 0.95-1.43), 1.08
(95% CI, 0.90-1.30), and 1.11 (95% CI, 0.91-1.35) for eGFRs �30, 30-44, 45-59, and �75 mL/min/1.73 m2,
respectively, compared with eGFRs of 60-74 mL/min/1.73 m2 for hospitalizations during �6 months of
follow-up. HRs were weaker for follow-up of 6-18 months. Dipstick-positive proteinuria was associated with an
increased HR throughout follow-up (HR, 1.29 [95% CI, 1.11-1.49], adjusting for cardiovascular risk factors).
Dipstick-positive proteinuria and eGFR �30 mL/min/1.73 m2 were independently associated with 2 or more
hospital admissions during the 2-year follow-up. Adjustment for other health factors and laboratory measurements
attenuated the effect of eGFR, but not the effect of proteinuria.
Limitations: follow-up limited to 2 years, selection bias due to nonparticipation in study, missing data for
potential covariates, and single noncalibrated measurements from multiple laboratories.
Conclusions: the study indicates that community-dwelling older people who have dipstick-positive proteinuria
and/or eGFR �30 mL/min/1.73 m2 are at increased risk of hospitalization.
|Keywords:||chronic kidney disease, cohort study, dipstick proteinuria testing, general population, hospitalization, older people|
|Subjects:||R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine
|Divisions:||Faculty of Medicine > Primary Care and Population Sciences
|Date Deposited:||13 Mar 2012 11:58|
|Last Modified:||13 Mar 2012 11:58|
|Contributors:||Nitsch , Dorothea (Author)
Nonyane, Bareng A.S. (Author)
Smeeth, Liam (Author)
Bulpitt, Christopher J. (Author)
Roderick, Paul J. (Author)
Fletcher, Astrid (Author)
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