![]() Patients with greater than 20 inpatient admissions during the study period were removed from the dataset as outliers. comorbidities and medications) because electronic medical records are not currently used in the outpatient setting at Austin Health. Only inpatient serum urea and serum creatinine results were used for analysis to ensure that sufficient patient information was available (e.g. Patients were included if they had serum urea and serum creatinine tests performed within 24-h of any inpatient admission following their first abnormal eGFR result. The study population included adult patients (aged ≥ 18 years) with at least two abnormal estimated glomerular filtration rate (eGFR) values (< 60 mL/min/1.73m 2) measured greater than 90-days apart between 1 January 2014 and 31 December 2018 in inpatient, outpatient or emergency department settings at Austin Health (Fig. This retrospective observational cohort study used Austin Health electronic medical record data extracted from The Data Analytics Research and Evaluation (DARE) Centre as outlined in a previous study 24. We hypothesised that elevated UCR would be associated with poorer inpatient clinical endpoints. The present study aims to examine the prevalence of elevated UCR in a tertiary hospital-based cohort of CKD patients, as well as its associated patient characteristics and clinical outcomes. The association between UCR and clinical outcomes in non-end stage CKD patients remains uncertain, however, with no current studies in this patient population. A more recent multicentre prospective study from Japan, demonstrated that UCR level at the time of dialysis initiation is associated with all-cause mortality, and is more strongly associated with mortality than eGFR or creatinine clearance alone 7. Several studies in haemodialysis patients have shown that UCR level is significantly associated with an increased risk for all-cause mortality 21, 22, infection-related death and incidence of coronary heart disease 23. Over the past decade, UCR has been strongly associated with poor clinical outcomes in various population settings, such as acute kidney injury (AKI) 8, 9, acute decompensated heart failure 3, 10, 11, 12, 13, 14, chronic heart failure 15, 16, 17, acute myocardial infarction 18, 19 and ischaemic stroke 20. Increases in serum urea out of proportion to serum creatinine result in an elevated UCR and reflect a critical condition. Serum urea levels can be further increased by excess protein intake, hypovolaemia, heart failure, gastrointestinal bleeding and catabolism 7. ![]() ![]() In renal failure, serum urea and creatinine levels usually rise proportionally with a progressive decline in renal function 4, 5, 6. Because this process is regulated by both neurohormonal activity and renal function, the urea-to-creatinine ratio (UCR) has been proposed to be of value in clinical practice. Creatinine is not reabsorbed and is excreted from the body, however, approximately 40–50% of urea is reabsorbed in the tubules, where it is linked to reabsorption of sodium and water 3. Due to their small molecular sizes, both creatinine and urea are filtered by the glomerulus 2. Urea has traditionally been thought to be a relatively inert molecule, however, recent experimental data has suggested that it induces biochemical alterations with a potential impact on clinical outcomes 1. The biological role of urea in chronic kidney disease (CKD) remains contentious. This warrants further investigation to understand the pathophysiological basis for this relationship and to identify effective interventions. Elevated urea-to-creatinine ratio is associated with poor clinical outcomes in chronic kidney disease inpatients. Despite this, there was no statistically significant association between higher urea-to-creatinine ratio and intensive care unit admission. Higher urea-to-creatinine ratio level was associated with greater rates of inpatient mortality, hospital readmission within 30-days and longer hospital length-of-stay. Age ≥ 65 years, female gender, gastrointestinal tract bleeding, heart failure, acute kidney injury and lower serum albumin were associated with elevated urea-to-creatinine ratio. This retrospective cohort study ( n = 11,156) included patients with at least two eGFR values 100 was present in 27.67% of hospital admissions. To better understand the role of the urea-to-creatinine ratio in chronic kidney disease patients, we assessed the epidemiology of the urea-to-creatinine ratio among hospitalised chronic kidney disease patients, and the association between the urea-to-creatinine ratio and inpatient clinical outcomes.
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