A JEYARUBAN1,2,3, WE HOY1,2, A CAMERON1,2, HG HEALY1,2,3, J ZHANG1,2, A MALLETT1,2,3
1CKD.QLD and NHMRC CKD.CRE, Brisbane, Australia, 2Faculty of Medicine, The University of Queensland, Herston, Australia, 3Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston, Australia
Aim: To explore factors that increase hospitalisation rates in patients diagnosed with CKD.
Background: Chronic kidney disease (CKD) is characterised by high hospitalisation and readmission rates.
Methods: A retrospective cohort study involved 1,123 RBWH patients enrolled in the CKD.QLD registry from January 2011 to August 2017 with a minimum of 2 years follow-up. Patients with renal replacement therapy prior to 2011 and patients with less than 2 years of biochemical data were excluded. Hospitalisation data and co-morbidities were extracted from clinical records. CKD stage and delta eGFR (CKD-EPI; stratified by quartiles) were deduced.
Results: 1,123 patients were identified with mean age 66.71 +/-16.2 years. Comorbidities included diabetes (46.8%), ischaemic heart disease (IHD; 29.5%), heart failure (7.6%), cerebrovascular events (CVD;10.6%), peripheral vascular disease (14%) and hypertension (74.2%). 19.6% of patients experienced an incident cardiovascular event (CVE).
CKD patients with CVE had a significant increase in hospitalisations compared to patients without CVE (mean:4.3(4.9) vs 8(6.8), p<0.05). Hospitalisations were significantly higher with advancing CKD stages with means; stage 1: 2.6(4.8), stage 2: 4.2(5.8), stage 3: 5(5.3), stage 4: 6(5.4), stage 5: 6(6), p<0.05. Patients in the fourth quartile delta eGFR(mL/min/1.73m²/yr) had significantly more hospitalisations than those in the first quartile of delta eGFR with means:5.5(5.5) vs 4.2(4.6) respectively (p=0.01). Moreover, patients with diabetes (6.0vs 4.2), IHD (6.8vs 4.3), heart failure (6.6vs 4.9) and CVD (6.2vs 4.9) also had significant increase (p<0.05) in hospitalisations. However multivariate analysis adjusting for age only showed a significant association between hospitalisations with CVE (p<0.05).
Conclusion: Many factors seem to be associated with increased hospitalisations in the CKD population. Identifying these factors, such as CVE, offers opportunities to decrease morbidity and health care costs.
Andrew Jeyaruban is currently a medical registrar with a keen interest in renal medicine. He graduated from James Cook University with Honours in 2014. Andrew then completed his residency at the Royal Brisbane and Women’s Hospital Brisbane, Australia. He is currently a basic physician trainee at the Liverpool Hospital, Sydney.