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CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom

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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
participants.

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.

Full text not available from this repository.

Citation

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), pp. 664-672. (doi:10.1053/j.ajkd.2010.09.026). (PMID:21146270).

More information

Published date: May 2011
Keywords: chronic kidney disease, cohort study, dipstick proteinuria testing, general population, hospitalization, older people
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 335448
URI: http://eprints.soton.ac.uk/id/eprint/335448
ISSN: 0272-6386
PURE UUID: 6de2d3a1-3e24-4ccd-af75-7253aabdcbd1
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 13 Mar 2012 11:58
Last modified: 18 Jul 2017 06:10

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Contributors

Author: Dorothea Nitsch
Author: Bareng A.S. Nonyane
Author: Liam Smeeth
Author: Christopher J. Bulpitt
Author: Astrid Fletcher

University divisions


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