Abstract: TH-PO547

Cause-Specific Hospitalization among Older Adults with CKD in the US (2006-2015)

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
  • He, Kevin, Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • Balkrishnan, Rajesh, University of Virginia School of Medicine, Charlottesville, Virginia, United States
  • Nallamothu, Brahmajee K., University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

Patients with CKD are at high risk of hospitalization, but there are few long-term studies of cause-specific hospitalizations in this vulnerable patient population. We examined these and long-term trends in hospitalization rates among older adults with CKD in the US.

Methods

We identified eligible CKD patients through claims (5% Medicare sample, 2006-2015). Patients were censored at the earliest of death, start of ESRD, disenrollment from Medicare Parts A&B or the last day of each calendar year. The cause of hospitalization was determined by principal ICD-9-CM diagnosis code. Adjusted hospitalization rates were calculated using a GLM with adjustment for age, gender and race.

Results

There was a notable decrease in the adjusted all-cause hospitalization rates among older CKD patients over the past decade, from 926.9/1000 patient years in 2006 to 739.0/1000 in 2011, with a steeper slope thereafter to 602.9/1000 in 2015 (Fig.1.a). Cardiovascular diseases (CVDs) and infections were the leading causes of hospitalization in CKD, accounting for 26% and 22% of all-cause admissions in 2015 (156.3/1,000 and 131.4/1,000). Congestive heart failure-related admissions were the most common CVD cause in CKD (Fig.1.b). Although overall infection-related hospitalization decreased over time, admissions resulting from bacteremia, septicemia and viremia increased by 51% and admissions due to nervous system infections increased by 42% (Fig.1.c).

Conclusion

While all-cause hospitalization rates among CKD patients gradually decreased in the past decade, CVD (especially heart failure related) and certain specific infections remained the leading causes. Future research will focus on preventable hospitalizations (e.g., septicemia, heart failure), disparities, geographic variation, costs, and care coordination.

Funding

  • NIDDK Support