ArticleThe journals of gerontology. Series A, Biological sciences and medical sciences2020
A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease.
Article in The journals of gerontology. Series A, Biological sciences and medical sciences, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Using electronic health records to understand multimorbidity in older people: a scoping review.European geriatric medicine · 2025Article
- Reserve and resilience in CKD: concept introduction and baseline results from the Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study.BMC nephrology · 2022Article
- Unintended Consequences of COVID-19 Social Distancing Among Older Adults With Kidney Disease.The journals of gerontology. Series A, Biological sciences and medical sciences · 2022Article
- A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study.JMIR human factors · 2021Article
- Blood Pressure Control Among Older Adults With Hypertension: Narrative Review and Introduction of a Framework for Improving Care.American journal of hypertension · 2021Review
- Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study.The journals of gerontology. Series A, Biological sciences and medical sciences · 2020Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundOlder 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.
methodsThis 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.
resultsOverall, 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.
conclusionA data-driven approach identified CKD-discordant indicators for a CKD-Discordance Index. Higher CKD-Discordance Index was associated with health care utilization and mortality.
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