Patients with CKD at increased risk for death depending on usual source of care
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Adults with chronic kidney disease who consider EDs or urgent care a usual source of care showed an increased risk for death and hospitalization, according to data published in Kidney Medicine.
“We hoped to understand the characteristics of patients with CKD who preferentially used the emergency room or urgent care center as their primary source of care,” Stephanie M. Toth-Manikowski, MD, MHS, an associate professor of medicine at the University of Illinois in Chicago, told Healio. “We hypothesized that patients who use the [ED] or urgent care (as opposed to a clinic) would be at higher risk for adverse outcomes. Our results showed that this was indeed the case, as these patients were at an increased risk for both hospitalizations and death.”
In a prospective observational study, researchers evaluated 3,140 adults (mean age 65 years; 44% were women; 45% were “non-Hispanic white”; 43% were “non-Hispanic Black”; and 9% were Hispanic) with moderate to severe CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. At baseline, participants provided sociodemographic, lifestyle and medical history information in a self-reported questionnaire.
The primary outcomes of the study included incident end-stage kidney disease, atherosclerotic events, incident heart failure, hospitalization events and all-cause death.
Using multivariable regression analyses, researchers measured the correlation between usual sources of care, such as ED or urgent care vs. clinic.
Among the 3,140 participants, 91% considered a clinic a usual source of care, 9% identified an ED/urgent care as a usual source of care and 1% reported “other” as a source. While 97% of the cohort had health insurance, those using ED or urgent care as a usual source of care were less likely to have private or commercial health insurance.
“In our study, approximately one out of every [10] patients with CKD used the ED or urgent care as their usual source of care,” Toth-Manikowski told Healio. “This group of individuals experienced a higher risk of adverse outcomes, including hospitalization and death, when compared to patients with CKD who used a clinic for their care. These individuals were also less likely to have optimized blood pressure and glycemic control and to take medications recommended in CKD (eg, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers). Identifying these patients is important so that clinicians can address any barriers that exist to establishing care in a clinic-based setting.”
Throughout a median follow-up of 3.6 years, researchers identified 181 incident ESKD events, 264 atherosclerotic events, 263 incident heart failure events, 288 deaths and 7,957 hospitalizations.
“We were surprised to find that patients seeking care in the ED or urgent care setting were highly insured (close to 100% reported having health insurance coverage),” Toth-Manikowski told Healio. “This speaks to the complexity of health care access in our society. As has been shown in other studies, health insurance coverage provides the potential for health care access, but it does not guarantee realization of this care. Further study is needed to understand these ongoing barriers to care.”
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