Adeera Levin1, Ognjenka Djurdjev, Monica Beaulieu, Lee Er. 1. Division of Nephrology, University of British Columbia, BC Provincial Renal Agency, Vancouver, British Columbia, Canada. alevin@providencehealth.bc.ca
Abstract
BACKGROUND: The outcomes of patients referred to nephrologists are not well described in large cohorts. The objectives of this analysis are to describe the predictors of rapid progression of kidney disease and death in patients followed up by nephrologists. STUDY DESIGN: Retrospective study. SETTING & PARTICIPANTS: A cohort derived from all patients registered in the provincial database was formed that included all patients with index estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m(2), at least 3 subsequent eGFR values, and 4 months of follow-up between January 2000 and January 2004. PREDICTORS: Variables used to predict outcomes included baseline eGFR, duration of follow-up before eGFR less than 30 mL/min/1.73 m(2), age, sex, ethnicity, presence of diabetes, blood pressure, level of proteinuria, hemoglobin level, phosphate level, calcium level, parathyroid hormone level, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, erythropoiesis-stimulating agents, and vitamin D. OUTCOMES: Key outcomes of interest were death, dialysis therapy start, or loss of GFR greater than 5 mL/min/1.73 m(2)/y. RESULTS: 4,231 patients met inclusion criteria. Mean age was 67 years. Median follow-up was 31 months. During the first 2 years of follow-up, 24% started dialysis therapy, 1% received a transplant, 7% died, and 1% was lost to follow-up. Statistically significant variables associated with more rapid kidney disease progression differ from those that predict death. Younger age, male sex, higher eGFR, higher systolic and diastolic blood pressure, lower hemoglobin level, higher phosphorus and parathyroid hormone levels, and greater proteinuria are associated with more rapid kidney disease progression, and use of angiotensin-converting enzymes/angiotensin receptor blockers are protective. Older age, lower diastolic blood pressure, lower hemoglobin level, and higher phosphorous and parathyroid hormone levels are associated with death, whereas vitamin D use is protective. LIMITATIONS: Results cannot be generalized to unreferred patients with eGFR less than 30 mL/min/1.73 m(2). CONCLUSION: The clinical course of patients with chronic kidney disease stage 4 is variable. Targeted therapy aimed at modifiable risk factors needs to be evaluated to determine benefits of this approach.
BACKGROUND: The outcomes of patients referred to nephrologists are not well described in large cohorts. The objectives of this analysis are to describe the predictors of rapid progression of kidney disease and death in patients followed up by nephrologists. STUDY DESIGN: Retrospective study. SETTING & PARTICIPANTS: A cohort derived from all patients registered in the provincial database was formed that included all patients with index estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m(2), at least 3 subsequent eGFR values, and 4 months of follow-up between January 2000 and January 2004. PREDICTORS: Variables used to predict outcomes included baseline eGFR, duration of follow-up before eGFR less than 30 mL/min/1.73 m(2), age, sex, ethnicity, presence of diabetes, blood pressure, level of proteinuria, hemoglobin level, phosphate level, calcium level, parathyroid hormone level, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, erythropoiesis-stimulating agents, and vitamin D. OUTCOMES: Key outcomes of interest were death, dialysis therapy start, or loss of GFR greater than 5 mL/min/1.73 m(2)/y. RESULTS: 4,231 patients met inclusion criteria. Mean age was 67 years. Median follow-up was 31 months. During the first 2 years of follow-up, 24% started dialysis therapy, 1% received a transplant, 7% died, and 1% was lost to follow-up. Statistically significant variables associated with more rapid kidney disease progression differ from those that predict death. Younger age, male sex, higher eGFR, higher systolic and diastolic blood pressure, lower hemoglobin level, higher phosphorus and parathyroid hormone levels, and greater proteinuria are associated with more rapid kidney disease progression, and use of angiotensin-converting enzymes/angiotensin receptor blockers are protective. Older age, lower diastolic blood pressure, lower hemoglobin level, and higher phosphorous and parathyroid hormone levels are associated with death, whereas vitamin D use is protective. LIMITATIONS: Results cannot be generalized to unreferred patients with eGFR less than 30 mL/min/1.73 m(2). CONCLUSION: The clinical course of patients with chronic kidney disease stage 4 is variable. Targeted therapy aimed at modifiable risk factors needs to be evaluated to determine benefits of this approach.
Authors: Sandra V Giannelli; Christophe E Graf; François R Herrmann; Jean-Pierre Michel; Kushang V Patel; Francesco Pizzarelli; Luigi Ferrucci; Jack Guralnik Journal: Rejuvenation Res Date: 2011-09-28 Impact factor: 4.663
Authors: Ann M O'Hare; Adam Batten; Nilka Ríos Burrows; Meda E Pavkov; Leslie Taylor; Indra Gupta; Jeff Todd-Stenberg; Charles Maynard; Rudolph A Rodriguez; Fliss E M Murtagh; Eric B Larson; Desmond E Williams Journal: Am J Kidney Dis Date: 2012-02-04 Impact factor: 8.860
Authors: J A Green; P L Ephraim; F F Hill-Briggs; T Browne; T S Strigo; C L Hauer; R A Stametz; J D Darer; U D Patel; K Lang-Lindsey; B L Bankes; S A Bolden; P Danielson; S Ruff; L Schmidt; A Swoboda; P Woods; B Vinson; D Littlewood; G Jackson; J F Pendergast; J St Clair Russell; K Collins; E Norfolk; I D Bucaloiu; S Kethireddy; C Collins; D Davis; J dePrisco; D Malloy; C J Diamantidis; S Fulmer; J Martin; D Schatell; N Tangri; A Sees; C Siegrist; J Breed; A Medley; E Graboski; J Billet; M Hackenberg; D Singer; S Stewart; A Alkon; N A Bhavsar; L Lewis-Boyer; C Martz; C Yule; R C Greer; M Saunders; B Cameron; L E Boulware Journal: Contemp Clin Trials Date: 2018-09-12 Impact factor: 2.226
Authors: Ai-Hua Zhang; Paul Tam; Denise LeBlanc; Hui Zhong; Christopher T Chan; Joanne M Bargman; Dimitrios G Oreopoulos Journal: Int Urol Nephrol Date: 2009-07-04 Impact factor: 2.370
Authors: Darbie Maccubbin; Diane Tipping; Olga Kuznetsova; William A Hanlon; Andrew G Bostom Journal: Clin J Am Soc Nephrol Date: 2010-03-18 Impact factor: 8.237
Authors: Claudio Rigatto; Adeera Levin; Andrew A House; Brendan Barrett; Euan Carlisle; Adrian Fine Journal: Clin J Am Soc Nephrol Date: 2009-01-14 Impact factor: 8.237