Patients with chronic kidney disease (CKD) who appear to have their kidneys functioning well enough without the need for specialist hospital care are at a much higher rate than the general population, a recent study found short.
The researchers also found that while cardiovascular disease was known to be the most common reason for patients with CKD patients to be admitted to the hospital, most stays are for other reasons, especially genitourinary disorders, digestive, and endocrine-nutritional-metabolic, according to the study, published in Medicine PLoS.
Among renal function tests, high protein levels in the urine were studied the most associated with hospitals, the study also found.
Authors based their findings on comparing data from hospitals of patients with CKD with a nationwide hospital database. Data were used from 3939 adults aged 21 and older (average age 57.7) enrolled in the Renal Illness Cohort (CRIC) Cohort Study from 2003-2008 at 7 clinical centers across the United States; participants were followed for nearly 10 years. The comparison was made with the National Patient Sample (NIS), which provided a cross-section of American adults since 2012.
The hospitalization rate for patients with CKD was 35.0 per 100 person years (PY) (95% CI, 34.3-35.6), with non-viral rates of 23.9 per 100 PY (95% CI, 23.3-24.4) and specific cardiovascular levels. less than one-third of total cause levels (11.1 per 100 PY; 95% CI, 10.8–11.5). Rates were higher among those aged 65 and older, non-Hispanic black participants, and those with diabetes.
Finding a higher hospital risk should have a far-reaching impact on primary health care providers as many of these patients would not be under the care of a kidney disease specialist, the study said. Less than 10% of individuals with an estimated glomerular filtration rate (eGFR) of <60 ml / min / 1.73m2 are seen by a nephrologist.
“These findings highlight the need to develop better approaches to get patients at risk for severe CKD complications and to manage outpatient management strategies to achieve results in Develop CKD, ”the authors wrote.
Research has shown that up to 15% -20% of American adults suffer from CKD. Patients with hospital-acquired CKD are at increased risk of complications, including reentry to hospital, higher mortality rates, longer patient stays, and worsening renal function, the study in mind.
The study found that overall rates for hospitalization and for cardiovascular disease in patients with CKD were twice as high as the general population. The findings were similar for non-viral disease hospitals, indicating that these patients of all ages are hospitalized for a wide range of reasons.
The literature has shown that cardiovascular disease represents the leading cause of hospitalization for patients with kidney disease (21-32%), followed by disease (22%), and digestive diseases (9% -11%) . However, this left large proportions of hospitals with unregistered causes. The new study found that nearly 70% of hospitals are not due to cardiovascular disease.
The study also identified features associated with more hospitals. They included a reserved eGFR (<60 ml/min/1.73m2), a systolic blood pressure level of > 130mmHG, and the presence of moderate to severe proteinuria. The researchers found that proteinuria was a strong risk factor for hospitalization. Hospitals were high among those with even moderate levels of proteinuria. Those with the heaviest rates had higher hospital admissions across a wide range of eGFRs.
The study found that genitourinary causes represented a large proportion of CKD hospitals, including conditions associated with kidney disease itself, such as chronic kidney injury and renal failure, as well as thyroid disorders. -urinary tract, including excess fluid in the kidneys as a result of urine retention, stones, and infections. Many hospitals are due to endocrine and nutritional issues – such as diabetes, thyroid disorders, and nutritional deficiencies – as well as possible causes of kidney disease, taking including gout, fluid and electrolyte disorders, and mineral metabolism disorders.
The study found that women with moderate-to-moderate CKD experienced less complete and non-cardiovascular hospitals but fewer cardiovascular hospitals, which may be associated with a higher incidence and severity. kidney disease complications in women. Blacks and Hispanics had more cardiovascular hospitalizations than White patients, probably because of their high rates of cardiovascular disease.
Information
Schrauben SJ, Chen HY, Lin E, et al. (2020) Hospitals among adults with chronic kidney disease in the United States: A cohort study. PLoS Med. Published online December 11, 2020; 17 (12): e1003470. doi: 10.1371 / journal.pmed.100347