Original InvestigationPathogenesis and Treatment of Kidney DiseasePotentially Preventable Hospitalization as a Complication of CKD: A Cohort Study
Section snippets
Methods
This study has been reported according to published guidelines.8
Study Cohort
Of 3,897,684 potentially eligible patients, 2,007,653 adult patients had an outpatient serum creatinine measurement between May 1, 2002, and March 31, 2009, and at least 3 years of prebaseline data (for assessment of comorbid conditions at baseline). Of these, 2,862 had prior end-stage renal disease (long-term renal replacement therapy or had received a kidney transplant) and 1,737 had baseline eGFRs < 15 mL/min/1.73 m2. Therefore, 2,003,054 participants were included in the study cohort (Fig 1).
Discussion
Avoiding the need for hospitalization is a clinically relevant outcome for patients, and the higher than average rate of hospitalization for people with CKD is an important driver of the high health care costs attributable to this population.15 For these reasons, there is substantial interest in using high-quality ambulatory care to prevent hospitalization in people with CKD.16 Efforts to achieve this objective have been hampered by an inability to distinguish potentially preventable from
Acknowledgements
We thank Sophanny Tiv for graphics support and Ghenette Houston for administrative support.
Support: This work was supported by a team grant to the Interdisciplinary Chronic Disease Collaboration from the Alberta Heritage Foundation for Medical Research (AHFMR). This work was supported in part by the Canadian Institutes for Health Research (200709MOP-178552-PUB-CBAA-62156) and a Leaders Opportunity Fund grant from the Canada Foundation for Innovation. Dr Tonelli is supported by an AHFMR
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Cited by (33)
Validation of Risk Prediction Models to Inform Clinical Decisions After Acute Kidney Injury
2021, American Journal of Kidney DiseasesCitation Excerpt :This reinforces the likelihood of there being missed opportunities to avoid readmissions, and the need for early monitoring (within 2 weeks) for many people rather than waiting until 90 days, which may be too late. Thus, clinical decision support systems for post-AKI care should be evaluated to ensure that care is appropriately timed as well as being targeted to those with greatest need.2,9,26 Strengths of this analysis include the population-based nature of our data sources, with capture of blood tests from all clinical locations in Grampian, to ensure that all people with AKI in the region can be identified and followed throughout a complete illness course.
Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD
2021, Kidney International ReportsCitation Excerpt :Certain comorbid conditions, such as anemia, may lead to hospitalizations if not well managed, but strategies to effectively manage anemia may reduce hospitalizations in individuals with advanced CKD.32 Our findings warrant additional research to investigate whether specific primary causes of hospitalization that are representative of ambulatory care–sensitive conditions22,33,34 may be preventable by interventions such as telehealth monitoring,35,36 home hospital services,15,37,38 or enhanced ambulatory care.11,16,17 Although it has been long understood that CKD increases the risks for hospitalization,3,6,13,14,26,27,29 most studies analyze time to first hospitalization and do not fully capture the global burden of hospitalizations.
Outpatient Interventions for Managing Acute Complications of Chronic Diseases: A Scoping Review and Implications for Patients With CKD
2020, American Journal of Kidney DiseasesCitation Excerpt :Home visits were conducted by physicians in 9 interventions and by nurses in all, with involvement of allied health professionals on the care team in 4 programs. Almost half the interventions (n = 7)26,28,33,35,36,38,39 indicated that they were operational 7 days per week, most often during daytime hours, with 4 specifying after-hours nursing or physician telephone support.9-41 All provided standard medical therapies in the home for patients meeting eligibility criteria (eg, clinical stability, proximity to hospital, and access to telephone and home support), but only 4 described the provision of patient education as part of the program.26,27,29,35
Determining the Association Between Continuity of Primary Care and Acute Care Use in Chronic Kidney Disease: A Retrospective Cohort Study
2022, Annals of Family MedicineCitation Excerpt :Because acute care utilization is notably high among people with CKD (ie, 3–8 times greater than in the general population), effective primary care continuity might address health system burden and improve care experiences among this medically complex population.9,10 Prior work has shown that approximately 10% of CKD-related acute care encounters are potentially preventable, given that they are related to conditions (ie, volume overload, hyperkalemia, malignant hypertension, heart failure) associated with CKD, and timely and effective care might avoid their onset or progression.11,12 However, associations between relational continuity of care in the primary care setting and all-cause and potentially preventable acute care use among patients with CKD have not been examined.
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A list of the members of the Alberta Kidney Disease Network is available at www.akdn.info.