Emergency Department/Urgent Care as Usual Source of Care and Clinical Outcomes in CKD: Findings From the Chronic Renal Insufficiency Cohort StudyPlain-Language Summary
Emergency Department/Urgent Care as Usual Source of Care and Clinical Outcomes in CKD: Findings From the Chronic Renal Insufficiency Cohort StudyPlain-Language Summary
Blog Article
Rationale & Objective: Having a usual source of care increases use of preventive services and is associated with improved survival in the general population.We evaluated this association in adults with chronic kidney disease (CKD).Study Design: Prospective, observational cohort study.Setting Girls Wetsuits & Participants: Adults with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study.
Predictor: Usual source of care was self-reported as: 1) clinic, 2) emergency department (ED)/urgent care, 3) other.Outcomes: Primary outcomes included incident end-stage kidney disease (ESKD), atherosclerotic events (myocardial infarction, stroke, or peripheral artery disease), incident heart failure, hospitalization events, and all-cause death.Analytical Approach: Multivariable regression analyses to evaluate the association between usual source of care (ED/urgent care vs clinic) and primary outcomes.Results: Among 3,140 participants, mean age was 65 years, 44% female, 45% non-Hispanic White, 43% non-Hispanic Black, and 9% Hispanic, mean estimated glomerular filtration rate 50 mL/min/1.
73 m2.Approximately 90% identified clinic as usual source of care, 9% ED/urgent care, and 1% other.ED/urgent care reflected a more vulnerable population given lower baseline socioeconomic status, higher comorbid condition burden, and poorer blood pressure and glycemic control.Over a median follow-up time of 3.
6 years, there were 181 Diffusers incident end-stage kidney disease events, 264 atherosclerotic events, 263 incident heart failure events, 288 deaths, and 7,957 hospitalizations.Compared to clinic as usual source of care, ED/urgent care was associated with higher risk for all-cause death (HR, 1.53; 95% CI, 1.05-2.
23) and hospitalizations (RR, 1.41; 95% CI, 1.32-1.51).
Limitations: Cannot be generalized to all patients with CKD.Causal relationships cannot be established.Conclusions: In this large, diverse cohort of adults with moderate-to-severe CKD, those identifying ED/urgent care as usual source of care were at increased risk for death and hospitalizations.These findings highlight the need to develop strategies to improve health care access for this high-risk population.