PMID- 34169199 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240402 IS - 2468-0249 (Electronic) IS - 2468-0249 (Linking) VI - 6 IP - 6 DP - 2021 Jun TI - Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD. PG - 1592-1602 LID - 10.1016/j.ekir.2021.03.883 [doi] AB - 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. CI - (c) 2021 International Society of Nephrology. Published by Elsevier Inc. FAU - Srivastava, Anand AU - Srivastava A AD - Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Cai, Xuan AU - Cai X AD - Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Mehta, Rupal AU - Mehta R AD - Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Lee, Jungwha AU - Lee J AD - Division of Biostatistics, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Chu, David I AU - Chu DI AD - Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. FAU - Mills, Katherine T AU - Mills KT AD - Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, and Tulane University Translational Science Institute, New Orleans, Louisiana, USA. FAU - Shafi, Tariq AU - Shafi T AD - Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. FAU - Taliercio, Jonathan J AU - Taliercio JJ AD - Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. FAU - Hsu, Jesse Y AU - Hsu JY AD - Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. FAU - Schrauben, Sarah J AU - Schrauben SJ AD - Division of Renal-Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA. FAU - Saunders, Milda R AU - Saunders MR AD - General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA. FAU - Diamantidis, Clarissa J AU - Diamantidis CJ AD - Divisions of General Internal Medicine and Nephrology and Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA. FAU - Hsu, Chi-Yuan AU - Hsu CY AD - Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA. FAU - Waikar, Sushrut S AU - Waikar SS AD - Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA. FAU - Lash, James P AU - Lash JP AD - Division of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences Center, University of Illinois College of Medicine, Chicago, Illinois, USA. FAU - Isakova, Tamara AU - Isakova T AD - Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. CN - CRIC Study Investigators LA - eng GR - UL1 TR002548/TR/NCATS NIH HHS/United States GR - U01 DK060980/DK/NIDDK NIH HHS/United States GR - R01 DK102438/DK/NIDDK NIH HHS/United States GR - UL1 TR000003/TR/NCATS NIH HHS/United States GR - KL2 TR001424/TR/NCATS NIH HHS/United States GR - UL1 TR000439/TR/NCATS NIH HHS/United States GR - K23 DK120811/DK/NIDDK NIH HHS/United States GR - U01 DK060990/DK/NIDDK NIH HHS/United States GR - U01 DK061028/DK/NIDDK NIH HHS/United States GR - UL1 TR000433/TR/NCATS NIH HHS/United States GR - U01 DK060984/DK/NIDDK NIH HHS/United States GR - U01 DK061021/DK/NIDDK NIH HHS/United States GR - U01 DK099930/DK/NIDDK NIH HHS/United States GR - U01 DK060963/DK/NIDDK NIH HHS/United States GR - K23 DK118198/DK/NIDDK NIH HHS/United States GR - U2C DK114886/DK/NIDDK NIH HHS/United States GR - UL1 RR024131/RR/NCRR NIH HHS/United States GR - K23 DK125670/DK/NIDDK NIH HHS/United States GR - UL1 TR001422/TR/NCATS NIH HHS/United States GR - U01 DK061022/DK/NIDDK NIH HHS/United States GR - K24 HL150235/HL/NHLBI NIH HHS/United States GR - UL1 TR000424/TR/NCATS NIH HHS/United States GR - M01 RR016500/RR/NCRR NIH HHS/United States GR - P20 GM109036/GM/NIGMS NIH HHS/United States GR - U01 DK060902/DK/NIDDK NIH HHS/United States GR - R01 DK110087/DK/NIDDK NIH HHS/United States GR - P30 DK114857/DK/NIDDK NIH HHS/United States GR - U24 DK114886/DK/NIDDK NIH HHS/United States GR - UL1 RR029879/RR/NCRR NIH HHS/United States PT - Journal Article DEP - 20210331 PL - United States TA - Kidney Int Rep JT - Kidney international reports JID - 101684752 PMC - PMC8207467 OTO - NOTNLM OT - chronic kidney disease OT - end-stage kidney disease OT - hospital utilization OT - hospitalization OT - trajectory FIR - Appel, Lawrence J IR - Appel LJ FIR - Feldman, Harold I IR - Feldman HI FIR - Go, Alan S IR - Go AS FIR - He, Jiang IR - He J FIR - Nelson, Robert G IR - Nelson RG FIR - Rahman, Mahboob IR - Rahman M FIR - Rao, Panduranga S IR - Rao PS FIR - Shah, Vallabh O IR - Shah VO FIR - Townsend, Raymond R IR - Townsend RR FIR - Unruh, Mark L IR - Unruh ML EDAT- 2021/06/26 06:00 MHDA- 2021/06/26 06:01 PMCR- 2021/03/31 CRDT- 2021/06/25 06:56 PHST- 2020/11/23 00:00 [received] PHST- 2021/02/10 00:00 [revised] PHST- 2021/03/08 00:00 [accepted] PHST- 2021/06/25 06:56 [entrez] PHST- 2021/06/26 06:00 [pubmed] PHST- 2021/06/26 06:01 [medline] PHST- 2021/03/31 00:00 [pmc-release] AID - S2468-0249(21)01031-7 [pii] AID - 10.1016/j.ekir.2021.03.883 [doi] PST - epublish SO - Kidney Int Rep. 2021 Mar 31;6(6):1592-1602. doi: 10.1016/j.ekir.2021.03.883. eCollection 2021 Jun.