Hospital Admissions in Chronic Kidney Disease and Comparison to those with Normal Renal Function

Abstract

Introduction and Aims: Chronic kidney disease (CKD) is associated with much mortality and morbidity. Part of this morbidity may be experienced as an in-patient in hospital. Admission to hospital is a major health event and has implications for health services, patients and their carers. The admission burden that might be attributable to CKD is not clear. We aimed to describe the burden of hospital admissions in the first and fifth year after a baseline measurement of renal function, categorising patients by their baseline level of renal function.

Methods: The GLOMMS-II cohort contained all individuals with a low eGFR (<60 ml/min/1.73m2) measured in the health service region in 2003 (in 1/3 of these the low eGFR was not present for at least 90 days i.e. not chronic); all those with raised PCR and ACR; all those receiving RRT; and a 20,000 sample of those with only normal eGFR measurements in 2003. Data-linkage to hospital episode statistics for the first and fifth subsequent years for each individual allowed a simple count of the number of admissions of all those still alive at the beginning of the first and fifth subsequent year to be made and the percentage with none, 1 to 5 and 6 or more admissions to be calculated. Those with stage 3-5 CKD (low eGFR for >90 days) and normal renal function are presented here.

Results: Of the 18687 with stage 3-5 CKD, 18137 were still alive at 1.1.2004 and 13091 at 1.1.2008. For the 19834 with normal renal function in 2003, the equivalent figures were 19595 and 18334. Overall 66% of those with stage 3 to 5 had no admissions in both 2004 and 2008, however this varied with level of renal function - only ~43% of stage 5 and ~69% of stage 3a. This is compared to ~81% of those with a normal measurement of renal function in 2003.

Conclusions: Those with CKD have a higher number of hospital admissions than those with normal renal function. Numbers of hospital admissions are higher with more advanced CKD, and this pattern is sustained over time. For the current time, CKD prevalence in a region could be used to augment health-care service planning, as a marker of potential health-care service use. In the future, exploration of reasons for admission could potentially identify alternative ways of managing these individuals that may not necessitate hospital admission.