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A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease.

Publication ,  Journal Article
Hall, RK; Zhou, H; Reynolds, K; Harrison, TN; Bowling, CB
Published in: J Gerontol A Biol Sci Med Sci
February 14, 2020

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 (ptrend < .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.

Duke Scholars

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Published In

J Gerontol A Biol Sci Med Sci

DOI

EISSN

1758-535X

Publication Date

February 14, 2020

Volume

75

Issue

3

Start / End Page

522 / 528

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Multimorbidity
  • Male
  • Humans
  • Gerontology
  • Female
  • Cohort Studies
  • Aged, 80 and over
  • Aged
 

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Hall, R. K., Zhou, H., Reynolds, K., Harrison, T. N., & Bowling, C. B. (2020). A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease. J Gerontol A Biol Sci Med Sci, 75(3), 522–528. https://doi.org/10.1093/gerona/glz248
Hall, Rasheeda K., Hui Zhou, Kristi Reynolds, Teresa N. Harrison, and C Barrett Bowling. “A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease.J Gerontol A Biol Sci Med Sci 75, no. 3 (February 14, 2020): 522–28. https://doi.org/10.1093/gerona/glz248.
Hall RK, Zhou H, Reynolds K, Harrison TN, Bowling CB. A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease. J Gerontol A Biol Sci Med Sci. 2020 Feb 14;75(3):522–8.
Hall, Rasheeda K., et al. “A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease.J Gerontol A Biol Sci Med Sci, vol. 75, no. 3, Feb. 2020, pp. 522–28. Pubmed, doi:10.1093/gerona/glz248.
Hall RK, Zhou H, Reynolds K, Harrison TN, Bowling CB. A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease. J Gerontol A Biol Sci Med Sci. 2020 Feb 14;75(3):522–528.
Journal cover image

Published In

J Gerontol A Biol Sci Med Sci

DOI

EISSN

1758-535X

Publication Date

February 14, 2020

Volume

75

Issue

3

Start / End Page

522 / 528

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Renal Insufficiency, Chronic
  • Multimorbidity
  • Male
  • Humans
  • Gerontology
  • Female
  • Cohort Studies
  • Aged, 80 and over
  • Aged