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Kidney Week

Abstract: FR-OR113

Cumulative All-Cause Hospitalization Trajectories and Risks of ESRD and Death in the Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Cai, Xuan, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Lee, Jungwha, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Mehta, Rupal, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Chu, David I., Ann & Robert H. Lurie Children''s Hospital of Chicago, Chicago, Illinois, United States
  • Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Saunders, Milda Renne, University of Chicago, Chicago, Illinois, United States
  • Diamantidis, Clarissa Jonas, Duke University School of Medicine, Durham, North Carolina, United States
  • Mills, Katherine T., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Taliercio, Jonathan J., Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
  • Shafi, Tariq, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Waikar, Sushrut S., Harvard Medical School, Boston, Massachusetts, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Isakova, Tamara, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Group or Team Name

  • CRIC Study Investigators
Background

Prior studies have not evaluated whether trajectories of all-cause hospitalization identify high-risk sub-phenotypes of patients with chronic kidney disease (CKD).

Methods

We evaluated data on 3012 participants of the CRIC Study who were alive and did not reach end stage renal disease (ESRD) during the first 4 years of follow up. To identify clinically distinct trajectories of cumulative all-cause hospitalization during 4 years, we performed trajectory analyses using latent class model. Trajectory analyses allow agnostic detection of subpopulations with distinct longitudinal patterns. Next, we fit multivariable-adjusted Cox proportional hazards models to assess the associations of trajectories of all-cause hospitalization with ESRD and with ESRD-censored death in participants who survived beyond their 5th annual visit.

Results

Trajectory analyses identified 3 discrete groups based on cumulative all-cause hospitalizations within the first 4 years of follow-up: none (n=1090), intermediate-utilizer (n=1785), or high-utilizer (n=137). Participants in the high-utilizer group were more likely to be black, have greater prevalence of diabetes mellitus and cardiovascular disease, have higher body mass index and albuminuria, and lower estimated glomerular filtration rate (eGFR). During a median follow-up time of 5.6 years, there were 544 ESRD events and 437 ESRD-censored deaths. High and intermediate utilizer trajectory groups were associated with a higher risk of ESRD and ESRD-censored death (Figure).

Conclusion

Trajectories of cumulative all-cause hospitalization identify subgroups of patients with CKD who have increased risks of ESRD and death independent of known risk factors including eGFR and albuminuria. Population health interventions should focus on patients with CKD with increasing cumulative all-cause hospitalizations.

Funding

  • NIDDK Support