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Chronic kidney disease and cause-specific hospitalisation: a matched cohort study using primary and secondary care patient data

Iwagami, M; Caplin, B; Smeeth, L; Tomlinson, LA; Nitsch, D; (2018) Chronic kidney disease and cause-specific hospitalisation: a matched cohort study using primary and secondary care patient data. British Journal of General Practice , 68 (673) e512-e523. 10.3399/bjgp18X697973. Green open access

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Abstract

BACKGROUND: Although chronic kidney disease (CKD) is associated with various outcomes, the burden of each condition for hospital admission is unknown. AIM: To quantify the association between CKD and cause-specific hospitalisation. DESIGN AND SETTING: A matched cohort study in primary care using Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. METHOD: Patients 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. RESULTS: In 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. CONCLUSION: Hospitalisations for heart failure, infection, and AKI showed strong associations with CKD in absolute and(or) relative terms, suggesting targets for improved preventive care.

Type: Article
Title: Chronic kidney disease and cause-specific hospitalisation: a matched cohort study using primary and secondary care patient data
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.3399/bjgp18X697973
Publisher version: http://doi.org/10.3399/bjgp18X697973
Language: English
Additional information: Copyright © Authors 2018. This article is Open Access: CC BY 4.0 licence (https://creativecommons.org/ licenses/by/4.0/).
Keywords: acute kidney injury, chronic kidney diseases, general practice, heart failure, hospitalisation, infection
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10053638
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