@article{abf74ebaeed842519a7cbc0a874699fa,
title = "Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD",
abstract = "Introduction: Management of chronic kidney disease (CKD) entails high medical complexity and often results in high hospitalization burden. There are limited data on the associations of longitudinal hospital utilization patterns with adverse clinical outcomes in individuals with CKD. Methods: We derived cumulative all-cause hospitalization trajectory groups using latent class trajectory analysis in 3012 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study who were alive and did not reach end-stage kidney disease (ESKD) within 4 years of study entry. Cox proportional hazards models tested the associations between hospitalization trajectory groups and risks of ESKD and death prior to the onset of ESKD (ESKD-censored death). Results: Within 4 years of study entry, there were 5658 hospitalizations among 3012 participants. We identified 3 distinct subgroups of individuals with CKD based on cumulative all-cause hospitalization trajectories over 4 years: low-utilizer (n = 1066), intermediate-utilizer (n = 1802), and high-utilizer (n = 144). High-utilizers represented a patient population of lower socioeconomic status who had a greater prevalence of comorbid conditions and lower kidney function compared with intermediate- and low-utilizers. After the 4-year ascertainment period to form the trajectory subgroups, there were 544 ESKD events and 437 ESKD-censored deaths during a median follow-up time of 5.1 years. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.49-fold (95% confidence interval [CI] 1.22–1.84) and 1.75-fold (95% CI 1.20–2.56) higher risk of ESKD in adjusted analyses, respectively. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.48-fold (95% CI 1.17–1.87) and 2.58-fold (95% CI 1.74–3.83) higher risk of ESKD-censored death in adjusted analyses, respectively. Conclusions: Trajectories of cumulative all-cause hospitalization identify subgroups of individuals with CKD who are at high risk of ESKD and death.",
keywords = "chronic kidney disease, end-stage kidney disease, hospital utilization, hospitalization, trajectory",
author = "{CRIC Study Investigators} and Anand Srivastava and Xuan Cai and Rupal Mehta and Jungwha Lee and Chu, {David I.} and Mills, {Katherine T.} and Tariq Shafi and Taliercio, {Jonathan J.} and Hsu, {Jesse Y.} and Schrauben, {Sarah J.} and Saunders, {Milda R.} and Diamantidis, {Clarissa J.} and Hsu, {Chi yuan} and Waikar, {Sushrut S.} and Lash, {James P.} and Tamara Isakova and Appel, {Lawrence J.} and Feldman, {Harold I.} and Go, {Alan S.} and Jiang He and Nelson, {Robert G.} and Mahboob Rahman and Rao, {Panduranga S.} and Shah, {Vallabh O.} and Townsend, {Raymond R.} and Unruh, {Mark L.}",
note = "Funding Information: This work was supported by the George M. O'Brien Kidney Research Center at Northwestern University (NU-GoKIDNEY; P30DK114857) from the National Institutes of Health (NIH) / National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). AS is supported by NIH grant K23DK120811, the Dixon Translational Research Grants Initiative at Northwestern Medicine and the Northwestern University Clinical and Translational Sciences Institute (UL1TR001422), and NIDDK Kidney Precision Medicine Project Opportunity Pool grant under U2CDK114886. RM is supported by grant KL2TR001424 from the NIH's National Center for Advancing Translational Sciences. DIC is supported by NIH grant K23DK125670. KTM is supported, in part, by grant P20GM109036 from the National Institute of General Medical Sciences. TI is supported by NIH grants R01DK102438, R01DK110087, and U01DK099930 from the NIDDK and K24HL150235 from the National Heart, Lung, and Blood Institute. Funding for the Chronic Renal Insufficiency Cohort study was obtained from grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902 under a cooperative agreement from NIDDK. In addition, this study was supported, in part, by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/National Center for Advancing Translational Sciences (UL1TR000003), the Johns Hopkins Institute for Clinical and Translational Research (UL1TR000424), University of Maryland General Clinical Research Center (M01RR-16500), Clinical and Translational Science Collaborative of Cleveland (UL1TR000439), Michigan Institute for Clinical and Health Research (UL1TR000433), University of Illinois at Chicago Clinical and Translational Science Awards (UL1RR029879), Tulane Center of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases (P20GM109036), and Kaiser Permanente National Institutes of Health/National Center for Research Resources University of California San Francisco Clinical and Translational Science Institute (UL1RR024131). Part of this work was presented as an oral presentation at the American Society of Nephrology Scientific Session on October 25, 2018, in San Diego, California. Concept and design: AS, JPL, TI; acquisition, analysis or interpretation of data: AS, XC, RM, JPL, TI; drafting of manuscript: AS, TI; critical revision of the manuscript for important intellectual content: all authors; statistical analysis: XC, AS, JL, JYH, TI; obtained funding: TI; administrative, technical, or material support: AS, XC, JPL, TI; supervision: AS, TI. Funding Information: This work was supported by the George M. O{\textquoteright}Brien Kidney Research Center at Northwestern University (NU-GoKIDNEY; P30DK114857) from the National Institutes of Health (NIH) / National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). AS is supported by NIH grant K23DK120811 , the Dixon Translational Research Grants Initiative at Northwestern Medicine and the Northwestern University Clinical and Translational Sciences Institute ( UL1TR001422 ), and NIDDK Kidney Precision Medicine Project Opportunity Pool grant under U2CDK114886. RM is supported by grant KL2TR001424 from the NIH{\textquoteright}s National Center for Advancing Translational Sciences. DIC is supported by NIH grant K23DK125670 . KTM is supported, in part, by grant P20GM109036 from the National Institute of General Medical Sciences . TI is supported by NIH grants R01DK102438, R01DK110087, and U01DK099930 from the NIDDK and K24HL150235 from the National Heart, Lung, and Blood Institute . Funding for the Chronic Renal Insufficiency Cohort study was obtained from grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902 under a cooperative agreement from NIDDK. In addition, this study was supported, in part, by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/ National Center for Advancing Translational Sciences ( UL1TR000003 ), the Johns Hopkins Institute for Clinical and Translational Research ( UL1TR000424 ), University of Maryland General Clinical Research Center ( M01RR-16500 ), Clinical and Translational Science Collaborative of Cleveland ( UL1TR000439 ), Michigan Institute for Clinical and Health Research ( UL1TR000433 ), University of Illinois at Chicago Clinical and Translational Science Awards ( UL1RR029879 ), Tulane Center of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases ( P20GM109036 ), and Kaiser Permanente National Institutes of Health / National Center for Research Resources University of California San Francisco Clinical and Translational Science Institute ( UL1RR024131 ). Publisher Copyright: {\textcopyright} 2021 International Society of Nephrology",
year = "2021",
month = jun,
doi = "10.1016/j.ekir.2021.03.883",
language = "English (US)",
volume = "6",
pages = "1592--1602",
journal = "Kidney International Reports",
issn = "2468-0249",
publisher = "Elsevier Inc.",
number = "6",
}