BACKGROUND AND OBJECTIVES: Population-based studies have reported outcomes and risk factors for patients with chronic kidney disease (CKD), defined primarily by decreased estimated GFR (eGFR). They are characterized by old age, low proteinuria level, and stage 3 CKD. However, many patients referred to nephrologists are younger and have overt proteinuria and advanced CKD. This study evaluated the association between outcomes and those factors among referred CKD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively reviewed 461 referred patients with stage 3 to 5 CKD from January 2003 to December 2007. Key outcomes were death and ESRD. Patients were followed from the time of first serum creatinine measurement to December 2009. RESULTS: The median age of subjects was 67.0 years, and median follow-up was 3.2 years. Overt proteinuria was present in 57.0% of subjects. For stage 3, 4, and 5 CKD, cumulative mortality and probability of ESRD at 3 years was 9.5 and 6.5%, 11.2 and 27.8%, and 16.5 and 79.1%, respectively. Using proportional-hazards regression models, age was a determinant for death, whereas overt proteinuria was strongly associated with ESRD. Among stage 3 CKD patients older than 65 years without overt proteinuria, the incidence of death before renal replacement therapy (RRT) was 2.8/100 patient-years and none had ESRD. In patients with advanced CKD and overt proteinuria, the incidence of ESRD was substantially higher than that of death before RRT. CONCLUSIONS: Stratification by age, proteinuria level, and CKD stage could predict the competing outcomes of death before RRT and ESRD among CKD patients.
BACKGROUND AND OBJECTIVES: Population-based studies have reported outcomes and risk factors for patients with chronic kidney disease (CKD), defined primarily by decreased estimated GFR (eGFR). They are characterized by old age, low proteinuria level, and stage 3 CKD. However, many patients referred to nephrologists are younger and have overt proteinuria and advanced CKD. This study evaluated the association between outcomes and those factors among referred CKDpatients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively reviewed 461 referred patients with stage 3 to 5 CKD from January 2003 to December 2007. Key outcomes were death and ESRD. Patients were followed from the time of first serum creatinine measurement to December 2009. RESULTS: The median age of subjects was 67.0 years, and median follow-up was 3.2 years. Overt proteinuria was present in 57.0% of subjects. For stage 3, 4, and 5 CKD, cumulative mortality and probability of ESRD at 3 years was 9.5 and 6.5%, 11.2 and 27.8%, and 16.5 and 79.1%, respectively. Using proportional-hazards regression models, age was a determinant for death, whereas overt proteinuria was strongly associated with ESRD. Among stage 3 CKDpatients older than 65 years without overt proteinuria, the incidence of death before renal replacement therapy (RRT) was 2.8/100 patient-years and none had ESRD. In patients with advanced CKD and overt proteinuria, the incidence of ESRD was substantially higher than that of death before RRT. CONCLUSIONS: Stratification by age, proteinuria level, and CKD stage could predict the competing outcomes of death before RRT and ESRD among CKDpatients.
Authors: Andrew S Levey; Daniel Cattran; Aaron Friedman; W Greg Miller; John Sedor; Katherine Tuttle; Bertram Kasiske; Thomas Hostetter Journal: Am J Kidney Dis Date: 2009-07-03 Impact factor: 8.860
Authors: Sharon Anderson; Jeffrey B Halter; William R Hazzard; Jonathan Himmelfarb; Frances McFarland Horne; George A Kaysen; John W Kusek; Susan G Nayfield; Kenneth Schmader; Ying Tian; John R Ashworth; Charles P Clayton; Ryan P Parker; Erika D Tarver; Nancy F Woolard; Kevin P High Journal: J Am Soc Nephrol Date: 2009-05-21 Impact factor: 10.121
Authors: Mark J Sarnak; Andrew S Levey; Anton C Schoolwerth; Josef Coresh; Bruce Culleton; L Lee Hamm; Peter A McCullough; Bertram L Kasiske; Ellie Kelepouris; Michael J Klag; Patrick Parfrey; Marc Pfeffer; Leopoldo Raij; David J Spinosa; Peter W Wilson Journal: Hypertension Date: 2003-11 Impact factor: 10.190
Authors: Morgan E Grams; Josef Coresh; Dorry L Segev; Lauren M Kucirka; Hocine Tighiouart; Mark J Sarnak Journal: Clin J Am Soc Nephrol Date: 2012-08-02 Impact factor: 8.237