Kidney Week

Abstract: SA-PO789

Assessing the Risk and Severity of Hospitalisations According to Level of Kidney Function: An EXTEND45 Analysis

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

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

Authors

• Jun, Min, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Min Jun,

• Sukkar, Louisa, The George Institute for Global Health, Sydney, New South Wales, Australia

Louisa Sukkar,

• Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia

Brendon Lange Neuen,

• Foote, Celine, The George Institute for Global Health, Sydney, New South Wales, Australia

Celine Foote,

• Rogers, Kris, The George Institute for Global Health, Sydney, New South Wales, Australia

Kris Rogers,

• Kang, Amy, The George Institute for Global Health, Sydney, New South Wales, Australia

Amy Kang,

• Scaria, Anish, The George Institute for Global Health, Sydney, New South Wales, Australia

Anish Scaria,

• Cass, Alan, Menzies School of Health Research, Darwin, Northern Territory, Australia

Alan Cass,

• Pollock, Carol A., The University of Sydney, St. Leonards, New South Wales, Australia

Carol A. Pollock,

• Knight, John, The George Institute for Global Health, Sydney, New South Wales, Australia

John Knight,

• Gallagher, Martin P., The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Martin P. Gallagher,

• Jardine, Meg J., The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia

Meg J. Jardine,

Group or Team Name

• EXTEND45 Study Steering Committee

Background

Contemporary assessments of the relationship between chronic kidney disease (CKD) and health services use in Australia by level of eGFR have been limited. Prior studies typically used diagnosis codes to identify CKD which have relatively low sensitivity for ascertaining earlier stages of CKD. We determined the risk and severity of all-cause and cardiovascular hospitalisations by eGFR in a community-based cohort study of adults aged ≥45 years in New South Wales, Australia.

Methods

Based on data from the EXTEND45 study (the 45 and Up Study linked to hospital and community pathology datasets by the Centre for Health Record and Linkage [CHeReL]), we identified a population-based cohort (2006-2014) of 41,099 people aged ≥45 who had a measure of kidney function (eGFR). The risk and severity of hospitalisations (defined by the hospitalisation length of stay [HLOS]) were assessed by eGFR category (≥90 [reference], 60-89, 45-59, 30-44 and <30ml/min/1.73m²) using multivariable Cox regression.

Results

Of 41,099 participants, 80.2% experienced ≥1 hospitalisation event over a mean follow-up of 5.8 years. All-cause hospitalisation risk increased as eGFR declined (HR 0.99 [95% CI:0.97-1.03]; 1.05 [1.00-1.09]; 1.17 [1.10-1.24] and 1.57 [1.43-1.72] for eGFR 60-89, 45-59, 30-44, and <30ml/min/1.73m², respectively; p-trend<0.001) even after adjustment for age and sex. Cardiovascular events rose even more steeply than all-cause hospitalisations (HR 1.23 [1.08-1.39]; 1.49 [1.28-1.73]; 1.73 [1.45-2.07] and 2.24 [1.80-2.79], respectively). Mean HLOS also increased as eGFR declined (all-cause hospitalisation [2.3, 2.8, 3.9, 5.1 and 5.7 days, respectively]; cardiovascular hospitalisations [3.7, 3.8, 5.7, 5.9 and 8.3 days, respectively).

Conclusion

In contemporary NSW, declining kidney function is associated with higher illness burden, particularly cardiovascular burden. The increased mean HLOS suggests that discrete medical events are more severe as kidney function declines.

Funding

• Commercial Support – The EXTEND45 Study is funded through peer-reviewed (NSW Cardiovascular Research Network Collaborative Project Grant) and unrestricted industry (from MSD, Amgen and Eli Lilly) research grants.