title: Chronic kidney disease and its association with mortality and hospitalization in Chinese nursing home older residents: a 3-year prospective cohort study.
abstract: OBJECTIVE
  To investigate chronic kidney disease (CKD) as a predictor of mortality and hospitalization in Chinese nursing homes older residents.
  
  
  METHODS
  A 3-year prospective multicenter cohort study.
  
  
  METHODS
  Nine nursing homes in Hong Kong.
  
  
  METHODS
  Nursing home older adults (812 total; 271 men and 571 women), mean age 86.0 ± 7.6.
  
  
  METHODS
  Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease Study (Chinese-adjusted), and participants were stratified into different severity of renal impairment according to the modified version of Kidney Disease Outcomes Quality Initiative (K/DOQI): stage 1 CKD: GFR > 90 mL/min/1.73 m(2); stage 2 CKD: 60-89 mL/min/1.73 m(2); stage 3A CKD: 45-59 mL/min/1.73 m(2); stage 3B CKD: 30-44 mL/min/1.73 m(2); stage 4/5: <30 mL/min/1.73 m(2). The outcome measures were the all-cause, infection-related, and cardiovascular-related mortality and hospitalizations.
  
  
  RESULTS
  Older adults with stage 3B and stage 4/5 CKD had higher all-cause, infection-related, and cardiovascular-related mortality than those with earlier stages of CKD. After multivariate analysis, stage 3B and stage 4/5 CKD were independent predictors of all-cause mortality (stage 3B, hazard ratio [HR]: 1.62, 95% CI: 1.12-2.33, P= .01; stage 4/5, HR: 2.00, 95% CI: 1.34-3.00, P= .001) and infection-related mortality (stage 3B, HR: 1.41, 95% CI: 1.08-2.30, P= .019; stage 4/5, HR: 1.91, 95% CI: 1.13-3.23, P= .016), but not cardiovascular-related mortalities. The all-cause, infection-related, and cardiovascular-related hospitalizations were significantly higher in older nursing home adults with stage 3B and stage 4/5 CKD.
  
  
  CONCLUSIONS
  In Chinese nursing home older adults, stage 3B and stage 4/5 CKD are independent predictors of all-cause and infection-related mortality. They also predict increased risks of all-cause, infection-related, and cardiovascular-related hospitalizations.
authors.affiliation: Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China. tuenching@yahoo.com.hk
authors.forename: Tuen Ching
authors.initials: TC
authors.lastname: Chan
authors.forename: Desmond Yat Hin
authors.initials: DY
authors.lastname: Yap
authors.forename: Yat Fung
authors.initials: YF
authors.lastname: Shea
authors.forename: James Ka Hay
authors.initials: JK
authors.lastname: Luk
authors.forename: Leung Wing
authors.initials: LW
authors.lastname: Chu
authors.forename: Felix Hon Wai
authors.initials: FH
authors.lastname: Chan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D009735:Nursing Homes; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology