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. 2021 Mar 16:8:20543581211001224.
doi: 10.1177/20543581211001224. eCollection 2021.

The Association Between Estimated Glomerular Filtration Rate and Hospitalization for Fatigue: A Population-Based Cohort Study

Janine F Farragher  1 , Jianguo Zhang  1 , Tyrone G Harrison  1   2 , Pietro Ravani  1   3 , Meghan J Elliott  1   2 , Brenda Hemmelgarn  1   2   3   4
Affiliations

The Association Between Estimated Glomerular Filtration Rate and Hospitalization for Fatigue: A Population-Based Cohort Study

Janine F Farragher et al. Can J Kidney Health Dis. .

Abstract
in English, French

Background: Fatigue is a pervasive symptom among patients with chronic kidney disease (CKD) that is associated with several adverse outcomes, but the incidence of hospitalization for fatigue is unknown.

Objective: To explore the association between estimated glomerular filtration rate (eGFR) and incidence of hospitalization for fatigue.

Design: Population-based retrospective cohort study using a provincial administrative dataset.

Setting: Alberta, Canada.

Patients: People above age 18 who had at least 1 outpatient serum creatinine measurement taken in Alberta between January 1, 2009, and December 31, 2016.

Measurements: The first outpatient serum creatinine was used to estimate GFR. Hospitalization for fatigue was identified using International Classification of Diseases, Tenth Revision (ICD-10) code R53.x.

Methods: Patients were stratified by CKD category based on their index eGFR. We used negative binomial regression to determine if there was an increased incidence of hospitalization for fatigue by declining kidney function (reference eGFR ≥ 60 mL/min/1.73m2). Estimates were stratified by age, and adjusted for age, sex, socioeconomic status, and comorbidity.

Results: The study cohort consisted of 2 823 270 adults, with a mean age of 46.1 years and median follow-up duration of 6.0 years; 5 422 hospitalizations for fatigue occurred over 14 703 914 person-years of follow-up. Adjusted rates of hospitalization for fatigue increased with decreasing kidney function, across all age strata. The highest rates were seen in adults on dialysis (adjusted incident rate ratios 24.47, 6.66, and 3.13 for those aged 18 to 64, 65 to 74, and 75+, respectively, compared with eGFR ≥ 60 mL/min/1.73m2).

Limitations: Fatigue hospitalization codes have not been validated; reference group limited to adults with at least 1 outpatient serum creatinine measurement; remaining potential for residual confounding.

Conclusions: Declining kidney function was associated with increased incidence of hospitalization for fatigue. Further research into ways to address fatigue in the CKD population is warranted.

Trial registration: Not applicable (not a clinical trial).

Contexte: La fatigue est un symptôme généralisé et associé à plusieurs effets indésirables chez les patients atteints d’insuffisance rénale chronique (IRC). L’incidence des hospitalisations liées à la fatigue est néanmoins inconnue.

Objectif: Examiner l’association entre le débit de filtration glomérulaire estimé (DFGe) et l’incidence d’hospitalization pour fatigue.

Type d’étude: Étude de cohorte rétrospective représentative d’une population et menée avec un ensemble de données administratives provinciales.

Cadre: Alberta, Canada.

Sujets: Les patients adultes de l’Alberta ayant eu au moins une mesure de créatinine sérique en consultation externe entre le 1er janvier 2009 et le 31 décembre 2016.

Mesures: La première mesure du taux de créatinine sérique en consultation externe a été utilisée pour estimer le DFG. L’hospitalization pour fatigue a été définie avec le code CIM-10 R53.x.

Méthodologie: Les patients ont été stratifiés par catégorie d’IRC en fonction de l’indice de DFGe. Une régression binomiale négative a servi à déterminer si le déclin de la fonction rénale (référence: DFGe ≥ 60 mL/min/1,73 m 2) menait à une incidence accrue d’hospitalization pour fatigue. Les estimations ont été stratifiées selon l’âge et corrigées en fonction de l’âge, du sexe, du statut socio-économique et des comorbidités.

Résultats: L’étude porte sur 2 823 270 adultes (âge moyen: 46,1 ans) dont la durée médiane de suivi s’établissait à 6,0 ans. Au cours des 14 703 914 années-personnes de suivi, 5 422 hospitalisations pour fatigue ont été répertoriées. Les taux corrigés d’hospitalization pour fatigue ont augmenté avec le déclin de la fonction rénale pour toutes les strates d’âges. Les taux les plus élevés ont été observés chez les patients dialysés (rapports des taux d’incidents corrigés: 24,47 [patients de 18 à 64 ans]; 6,66 [patients de 65 à 74 ans] et 3,13 [patients de 75 ans et plus] comparativement à un DFGe ≥ 60 mL/min/1,73 m2).

Limites: Les codes d’hospitalization pour fatigue n’ont pas été validés; le groupe de référence a été limité aux adultes ayant au moins une mesure de créatinine sérique en consultation externe; possibilité de facteurs de confusion résiduels.

Conclusion: Le déclin de la fonction rénale a été associé à une incidence accrue d’hospitalization pour fatigue. Ces résultats justifient de poursuivre les recherches sur les moyens de remédier à la fatigue chez les patients atteints d’IRC.

Keywords: chronic kidney disease; dialysis; fatigue; hospitalization.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors have no conflicts of interest to declare. This study is based in part on data provided by Alberta Health and Alberta Health Services. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta or Alberta Health Services. Neither the Government of Alberta nor Alberta Health or Alberta Health Services express any opinion in relation to this study. The results presented in this paper have not been published previously in whole or part, except in abstract format.

Figures

Figure 1.
Figure 1.
Incidence of hospitalization for fatigue, stratified by age and kidney function. Note. eGFR = estimated glomerular filtration rate; IRR = incidence rate ratio; CI = confidence interval; IR = incidence rate.
See this image and copyright information in PMC

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