A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease
A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease
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DOI：
10.1093/gerona/glz248
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发表时间：
2020-03-01
影响因子：
5.1
通讯作者：
Bowling, C. Barrett
中科院分区：
文献类型：
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作者：
Hall, Rasheeda K.;Zhou, Hui;Bowling, C. Barrett
背景慢性肾脏病（CKD）-不一致性疾病（合并有治疗建议的疾病，可能使CKD管理复杂化）的老年人住院和死亡风险较高。我们的目标是开发一个CKD不一致指数，使用电子健康记录，以提高识别discordance.Methods回顾性队列研究包括凯泽永久南加州患者年龄≥ 65岁及以上的事件CKD（N = 30,932）。为了指导将疾病纳入指数并对每种疾病进行加权，我们首先使用考克斯回归开发了一个1年住院风险的预测模型。点的分配与模型得出的回归系数成比例。接下来，CKD不一致指数计算为个体的总分除以最大可能的不一致点。CKD不一致指数和住院率、急诊就诊率和死亡率之间的关系采用多变量调整的考克斯回归模型进行评估。结果总体而言，平均（SD）年龄为77.9（7.6）岁，55%的参与者为女性，59.3%为白色，32%（n = 9，869）在1年随访期间住院≥ 1次。CKD不一致指数包括以下变量：心力衰竭、胃食管反流病/消化性溃疡病、骨关节炎、痴呆、抑郁、癌症、慢性阻塞性肺病/哮喘，以及有4名或4名以上处方者。与CKD不一致指数为0的患者相比，CKD不一致指数为0.001-0.24和>= 0.25的患者住院的校正风险比（95%置信区间）分别为1.39（1.27-1.51）和1.81（1.64-2.01）（p（趋势）< .001）。一个分级模式的风险被视为急诊科就诊和全因mortals.Conclusion一个数据驱动的方法确定CKD不一致的指标CKD不一致指数。较高的CKD不一致指数与医疗保健利用和死亡率相关。
Background Older adults with chronic kidney disease (CKD)-discordant conditions (comorbid conditions with treatment recommendations that potentially complicate CKD management) have higher risk of hospitalization and death. Our goal is to develop a CKD-Discordance Index using electronic health records to improve recognition of discordance.Methods This retrospective cohort study included Kaiser Permanente Southern California patients aged >= 65 years and older with incident CKD (N = 30,932). To guide inclusion of conditions in the Index and weight each condition, we first developed a prediction model for 1-year hospitalization risk using Cox regression. Points were assigned proportional to regression coefficients derived from the model. Next, the CKD-Discordance Index was calculated as an individual's total points divided by the maximum possible discordance points. The association between CKD-Discordance Index and hospitalizations, emergency department visits, and mortality was accessed using multivariable-adjusted Cox regression model.Results Overall, mean (SD) age was 77.9 (7.6) years, 55% of participants were female, 59.3% were white, and 32% (n = 9,869) had >= 1 hospitalization during 1 year of follow-up. The CKD-Discordance Index included the following variables: heart failure, gastroesophageal reflux disease/peptic ulcer disease, osteoarthritis, dementia, depression, cancer, chronic obstructive pulmonary disease/asthma, and having four or more prescribers. Compared to those with a CKD-Discordance Index of 0, adjusted hazard ratios (95% confidence interval) for hospitalization were 1.39 (1.27-1.51) and 1.81 (1.64-2.01) for those with a CKD-Discordance Index of 0.001-0.24 and >= 0.25, respectively (p(trend) < .001). A graded pattern of risk was seen for emergency department visits and all-cause mortality.Conclusion A data-driven approach identified CKD-discordant indicators for a CKD-Discordance Index. Higher CKD-Discordance Index was associated with health care utilization and mortality.