title: Potentially preventable hospitalization as a complication of CKD: a cohort study.
abstract: BACKGROUND
  Ambulatory care-sensitive conditions have been described as those that (if appropriately managed in an outpatient setting) generally do not require subsequent hospitalization. Our goal was to identify clinical populations of people who are at the highest risk of ambulatory care-sensitive conditions related to chronic kidney disease (CKD).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  2,003,054 adults (including 238,747 adults with CKD) residing in Alberta, Canada, with at least one serum creatinine measurement between 2002 and 2009.
  
  
  METHODS
  Estimated glomerular filtration rate and albuminuria categories, CKD status, demographics, and clinical characteristics.
  
  
  RESULTS
  Hospitalization with heart failure, hyperkalemia, volume overload, or malignant hypertension.
  
  
  METHODS
  We used the Alberta Kidney Disease Network database, which incorporates data from Alberta Health, the Northern and Southern Alberta Renal Programs, and clinical laboratories in Alberta.
  
  
  RESULTS
  During a median follow-up of 4.1 years, 43,863 participants were hospitalized for heart failure; 6,274 participants, for hyperkalemia; 2,035 participants, for volume overload; and 481 participants, for malignant hypertension. All 4 conditions were more common at lower estimated glomerular filtration rates and in the presence of albuminuria. In the subset of participants with CKD, heart failure, hyperkalemia, and volume overload were associated most strongly with older age, diabetes, chronic liver disease, and prior heart failure. Malignant hypertension was associated with prior hypertension, aboriginal status, and peripheral vascular disease. Remote-dwelling participants were more likely to experience heart failure and malignant hypertension than those living closer to providers.
  
  
  CONCLUSIONS
  No data for medication use or potentially important process-based outcomes for study participants.
  
  
  CONCLUSIONS
  Our findings suggest that future studies seeking to determine how to prevent ambulatory care-sensitive conditions in people with CKD should target remote dwellers and those with comorbid conditions such as concomitant heart failure and liver disease.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: Natasha
authors.initials: N
authors.lastname: Wiebe
authors.affiliation: Department of Medicine, University of Alberta, Edmonton; Department of Public Health Sciences, University of Alberta, Edmonton.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Klarenbach
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Allan
authors.affiliation: Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: The Spatial Information Systems Laboratory, University of Alberta, Edmonton, Canada.
authors.forename: Rick
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: Aminu
authors.initials: A
authors.lastname: Bello
authors.affiliation: Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Department of Medicine, University of Alberta, Edmonton; Department of Public Health Sciences, University of Alberta, Edmonton. Electronic address: celloadm@ualberta.ca.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: Chronic kidney disease (CKD); access to care; adverse clinical outcome; ambulatory care−sensitive condition (ACSC); comorbid condition; outpatient care; preventable hospitalization