biostudies-literatureSrivastava ANCATS NIH HHSNCRR NIH HHSNIDDK NIH HHSNHLBI NIH HHSNIDDKNIGMS NIH HHS1592-1602https://www.ebi.ac.uk/biostudies/studies/S-EPMC8207467biostudies-literatureUnknown6(6)<h4>Introduction</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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 (<i>n</i> = 1066), intermediate-utilizer (<i>n</i> = 1802), and high-utilizer (<i>n</i> = 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.<h4>Conclusions</h4>Trajectories of cumulative all-cause hospitalization identify subgroups of individuals with CKD who are at high risk of ESKD and death.Kidney international reportsHospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD.PMC8207467P20 GM109036K23 DK118198U01 DK061021U01 DK060990K24 HL150235U01 DK061022UL1 TR001422UL1 RR029879U01 DK061028UL1 TR000433UL1 TR000439M01 RR016500K23 DK125670U01 DK060902UL1 RR024131R01 DK110087UL1 TR000003U01 DK060963UL1 TR002548UL1 TR000424U01 DK060984U01 DK060980KL2 TR001424P30 DK114857U01 DK099930K23 DK120811U2C DK114886R01 DK102438Waikar SSMehta RDiamantidis CJLee JUnruh MLHsu CYIsakova TSrivastava AGo ASFeldman HICRIC Study InvestigatorsTownsend RRRao PSChu DILash JPSaunders MRSchrauben SJShah VOHsu JYHe JNelson RGShafi TMills KTTaliercio JJRahman MAppel LJCai XfalseHospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD.<h4>Introduction</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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 (<i>n</i> = 1066), intermediate-utilizer (<i>n</i> = 1802), and high-utilizer (<i>n</i> = 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.<h4>Conclusions</h4>Trajectories of cumulative all-cause hospitalization identify subgroups of individuals with CKD who are at high risk of ESKD and death.2021-01-01T00:00:00Z2021 Jun2024-10-19T03:33:39.428Z2022-02-10T15:52:43.756ZS-EPMC82074673416919910.1016/j.ekir.2021.03.883