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Kidney Week

Abstract: PO0497

Usual Source of Care and Clinical Outcomes in Adults with CKD: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Toth-Manikowski, Stephanie M., University of Illinois at Chicago, Chicago, Illinois, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Fischer, Michael J., University of Illinois at Chicago, Chicago, Illinois, United States
  • Cohen, Jordana B., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Lora, Claudia M., University of Illinois at Chicago, Chicago, Illinois, United States
  • Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Greer, Raquel C., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Saunders, Milda Renne, University of Chicago, Chicago, Illinois, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
Background

In general populations, having a usual source of care (USOC) increases use of preventive care and is associated with higher survival. However, there are limited data in adults with chronic kidney disease (CKD).

Methods

In the CRIC Study, we categorized participants’ self-reported USOC as follows: 1) clinic/doctor’s office, 2) emergency room (ER)/urgent care, and 3) other. Using multivariable regression analyses, we evaluated the association between USOC and incident end stage renal disease (ESRD), cardiovascular events (myocardial infarction, heart failure, stroke and peripheral arterial disease), hospitalizations, and all-cause death.

Results

Among 3,140 participants, mean age was 65 years, 45% were non-Hispanic white, 43% non-Hispanic black, 9% Hispanic, and mean estimated glomerular filtration rate (eGFR) was 50 mL/min/1.73m2. 90% identified clinic/doctor’s office as USOC, 9% ER/urgent care, and 1% other. Over a median follow-up time of 3.6 years, there were 288 deaths, 181 incident ESRD events, 444 cardiovascular events, and 7,957 hospitalizations. In multivariable analyses, compared to clinic/doctor’s office as USOC, ER/urgent care was associated with higher risk for death and hospitalizations (Table). No significant association was seen with incident ESRD or cardiovascular events.

Conclusion

ER/urgent care as USOC was associated with higher risk for adverse outcomes in this large and diverse adult cohort with CKD. Further studies are needed to identify barriers to accessing appropriate preventive care to reduce negative health outcomes in this population.

Association between usual source of care (ER/urgent care vs. clinic/doctor’s office) and outcomes
OutcomeHR (95% CI)
Incident ESRD0.86 (0.49-1.52)
Cardiovascular Events1.28 (0.94-1.75)
All-Cause Death1.53 (1.05-2.23)*
 RR (95% CI)
Hospitalizations1.41 (1.32-1.51)*

*p<0.05; Results adjusted for clinical center, age, sex, race, education, income, smoking status, physical activity, HbA1c<7%, statin, aspirin, ACEI/ARB, eGFR, urine protein.

Funding

  • NIDDK Support