Background: Patients with chronic kidney disease (CKD) who are hospitalized with a critical illness are at increased risk for adverse outcomes. We studied the predictors of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 in a safety-net healthcare setting. Methods: A retrospective cohort study was conducted among patients ≥18 years of age with CKD stages 3 and 4 using a CKD registry from a safety-net healthcare system. Hospitalizations with critical illness were identified among patients requiring nonelective admission or transfer to the intermediate or intensive care unit during a 3-year period after the diagnosis of CKD. Poisson regression was used to determine associations between baseline characteristics and hospitalization requiring intermediate or intensive care among all CKD patients and in those with different stages of CKD. Outcomes of these hospitalizations were also tabulated. Results: Among 8,302 patients with CKD stages 3 and 4, 1,298 were hospitalized and 495 required intermediate or intensive care during a 3-year follow-up period. In the adjusted analysis, advanced CKD, Hispanics (incident rate ratio [IRR]: 1.88), non-Hispanic Blacks (IRR: 1.48), presence of congestive heart failure (IRR: 2.09), cardiovascular disease (IRR: 1.57), chronic pulmonary disease (IRR: 1.60), liver disease, malignancy, and anemia were associated with higher risk of hospitalization requiring intermediate or intensive care. The association of age, gender, race/ethnicity, congestive heart failure, anemia, and body mass index with hospitalization requiring intermediate or intensive care differed significantly by CKD stage (p value for interaction term #x3c;0.05). Congestive heart failure and severity of anemia were associated with a higher risk of hospitalization requiring intermediate or intensive care among patients with mild CKD, and the magnitude of association attenuated among patients with advanced CKD. Conclusions: The burden of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 remains high and was associated with demographic factors and comorbid medical conditions, especially among those with congestive heart failure and cardiovascular disease. Targeted, effective interventions to reduce the burden of hospitalization and critical illness in CKD patients within safety-net healthcare systems are needed.
Cardiorenal Med

中文翻译：

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[慢性肾病住院与危重病]。

背景：慢性肾病 (CKD) 患者因危重住院而出现不良结局的风险增加。我们在安全网医疗保健环境中研究了非透析依赖型 CKD 3 和 4 期患者因危重病住院的预测因素。方法：使用来自安全网医疗保健系统的 CKD 注册表，在 18 岁以上 CKD 3 期和 4 期患者中进行了一项回顾性队列研究。在 CKD 诊断后的 3 年内需要非选择性入院或转入中级或重症监护病房的患者中，确定了重症住院。泊松回归用于确定所有 CKD 患者和 CKD 不同阶段患者的基线特征与需要中级或重症监护的住院之间的关联。还列出了这些住院治疗的结果。结果：在 8,302 名 CKD 3 和 4 期患者中，1,298 人住院，495 人在 3 年随访期间需要中级或重症监护。在调整后的分析中，晚期 CKD、西班牙裔（发病率比 [IRR]：1.88）、非西班牙裔黑人（IRR：1.48）、存在充血性心力衰竭（IRR：2.09）、心血管疾病（IRR：1.57）、慢性肺部疾病（IRR：1.60）、肝脏疾病、恶性肿瘤和贫血与需要中级或重症监护的住院风险较高相关。年龄、性别、种族/民族、充血性心力衰竭、贫血和体重指数与需要中级或重症监护住院的相关性因 CKD 分期而显着不同（p交互项 #x3c;0.05 的值）。在轻度 CKD 患者中，充血性心力衰竭和贫血严重程度与需要中级或重症监护的住院风险较高相关，而在晚期 CKD 患者中，相关程度减弱。结论：非透析依赖型 CKD 3 期和 4 期患者的危重病住院负担仍然很高，并且与人口统计学因素和合并症有关，尤其是充血性心力衰竭和心血管疾病患者。需要有针对性、有效的干预措施，以减少安全网医疗保健系统内 CKD 患者的住院和危重疾病负担。
心肾医学