Hospitalization Risk among Older Adults with Chronic Kidney Disease

Am J Nephrol. 2019;50(3):212-220. doi: 10.1159/000501539. Epub 2019 Jul 16.

Abstract

Introduction: Chronic kidney disease (CKD) risk staging is based on estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). However, the relationship between all-cause hospitalization risk and the current CKD staging system has not been well studied among older adults, despite a high prevalence of CKD and a high risk of hospitalization in old age.

Methods: Among 4,766 participants of the Atherosclerosis Risk in Communities study, CKD was staged according to Kidney Disease Improving Global Outcomes (KDIGO) criteria, using creatinine-based eGFR (eGFRcr) and ACR. Incidence rates of all-cause hospitalization associated with each CKD risk group were analyzed using negative binomial regression. Additionally, cause-specific hospitalization risks for cardiovascular, infectious, kidney, and other diseases were estimated. The impacts of using cystatin C-based eGFR (eGFRcys) to estimate the prevalence of CKD and risks of hospitalization were also quantified.

Results: Participants experienced 5,548 hospitalizations and 29% had CKD. Hospitalization rates per 1,000 person-years according to KDIGO risk categories were 208-223 ("low risk"), 288-376 ("moderately increased risk"), 363-548 ("high risk"), and 499-1083 ("very high risk"). The increased risk associated with low eGFR and high ACR persisted in adjusted analyses, examinations of cause-specific hospitalizations, and when CKD was staged by eGFRcys or eGFRcr-cys, a combined equation based on both creatinine and cystatin C. In comparison to eGFRcr, staging by eGFRcys increased the prevalence of CKD to 50%, but hospitalization risks remained similarly high.

Discussion/conclusion: In older adults, decreased eGFR, increased ACR, and KDIGO risk stages based on a combination of these measures, were strong risk factors for hospitalization. These relationships were consistent, regardless of the marker used to estimate GFR, but the use of cystatin C resulted in a substantially higher prevalence of CKD than the use of creatinine. Older adults in the population with very high risk stages of CKD have hospitalization rates exceeding 500 per 1,000 person-years.

Keywords: Aging; Albuminuria; Chronic kidney disease; Estimated glomerular filtration rate; Hospitalization.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging
  • Albumins / analysis
  • Albuminuria
  • Creatinine / blood
  • Cystatin C / metabolism
  • Female
  • Glomerular Filtration Rate
  • Hospitalization*
  • Humans
  • Kidney / pathology
  • Male
  • Middle Aged
  • Quality of Life
  • Regression Analysis
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / therapy*
  • Risk

Substances

  • Albumins
  • Cystatin C
  • Creatinine