Abstract
BackgroundAlthough chronic kidney disease (CKD) is associated with various outcomes, the burden of each condition for hospital admission is unknown.AimTo quantify the association between CKD and cause-specific hospitalisation.Design and settingA matched cohort study in primary care using Clinical Practice Research Datalink linked to Hospital Episode Statistics in England.MethodPatients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and a comparison group of patients without known CKD (matched for age, sex, GP, and calendar time) were identified, 2004–2014. Outcomes were hospitalisations with 10 common conditions as the primary admission diagnosis: heart failure; urinary tract infection; pneumonia; acute kidney injury (AKI); myocardial infarction; cerebral infarction; gastrointestinal bleeding; hip fracture; venous thromboembolism; and intracranial bleeding. A difference in the incidence rate of first hospitalisation for each condition was estimated between matched patients with and without CKD. Multivariable Cox regression was used to estimate a relative risk for each outcome.ResultsIn a cohort of 242 349 pairs of patients, with and without CKD, the rate difference was largest for heart failure at 6.6/1000 person-years (9.7/1000 versus 3.1/1000 person-years in patients with and without CKD, respectively), followed by urinary tract infection at 5.2, pneumonia at 4.4, and AKI at 4.1/1000 person-years. The relative risk was highest for AKI with a fully adjusted hazard ratio of 4.90, 95% confidence interval (CI) = 4.47 to 5.38, followed by heart failure with 1.66, 95% CI = 1.59 to 1.75.ConclusionHospitalisations for heart failure, infection, and AKI showed strong associations with CKD in absolute and(or) relative terms, suggesting targets for improved preventive care.
Highlights
Chronic kidney disease (CKD) is a common condition in the community.[1,2] In the UK, according to the Quality and Outcomes Framework,[3] GPs have been incentivised to register patients with chronic kidney disease (CKD) stages 3–5 since 2006
In the UK, according to the Quality and Outcomes Framework,[3] GPs have been incentivised to register patients with CKD stages 3–5 since 2006. The majority of these patients are in CKD stage 3 and managed by GPs without referral to nephrology services.[4]
This study aimed to quantify the association between CKD and causespecific hospitalisation, using a primary care database linked to hospital admission data
Summary
Chronic kidney disease (CKD) is a common condition in the community.[1,2] In the UK, according to the Quality and Outcomes Framework,[3] GPs have been incentivised to register patients with CKD stages 3–5 (estimated glomerular filtration rate [eGFR]
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