BACKGROUND: Chronic kidney disease (CKD) progression among German patients in a representative setting has not been described previously. The Verband Deutsche Nierenzentren and Chronic Kidney Disease Outcomes and Practice Patterns Study established a longitudinal observational cohort among German CKD patients to research variations in patient care and outcomes in real-world nephrology practices. METHODS: A cohort of CKD Stages 3 (25%) and 4 (75%) patients was established from German nephrologist-run CKD clinics in 2013-16. Linear models were used to determine the estimated glomerular filtration rate (eGFR) slope during follow-up and Cox models were used to assess outcomes of end-stage kidney disease (ESKD) and death. RESULTS: A total of 1834 patients (median age 75 years, 58% male, 42% diabetics, median baseline eGFR 25 mL/min/1.73 m2) were followed for a median of 29 months. More than 50% had slow or no decline and 17% declined ≥5 mL/min/1.73 m2/year. After 4.5 years, the incidence of ESKD was 8% and of deaths without ESKD 16% among patients with eGFR ≥30 mL/min/1.73 m2 and 37% and 19% for eGFR <30 mL/min/1.73 m2. Adjusted models showed higher risks of ESKD or death for patients with worse kidney function at baseline, male sex, diabetes and higher blood pressure; a higher risk of ESKD with higher albuminuria; and a higher risk of death with older age or cardiovascular comorbidity. CONCLUSIONS: Routine nephrology care of patients in Germany comprises mostly elderly patients, many with slow CKD progression. Identification of risk factors for CKD progression and mortality may help guide resources by closer follow-up of high-risk patients.
BACKGROUND:Chronic kidney disease (CKD) progression among German patients in a representative setting has not been described previously. The Verband Deutsche Nierenzentren and Chronic Kidney Disease Outcomes and Practice Patterns Study established a longitudinal observational cohort among German CKDpatients to research variations in patient care and outcomes in real-world nephrology practices. METHODS: A cohort of CKD Stages 3 (25%) and 4 (75%) patients was established from German nephrologist-run CKD clinics in 2013-16. Linear models were used to determine the estimated glomerular filtration rate (eGFR) slope during follow-up and Cox models were used to assess outcomes of end-stage kidney disease (ESKD) and death. RESULTS: A total of 1834 patients (median age 75 years, 58% male, 42% diabetics, median baseline eGFR 25 mL/min/1.73 m2) were followed for a median of 29 months. More than 50% had slow or no decline and 17% declined ≥5 mL/min/1.73 m2/year. After 4.5 years, the incidence of ESKD was 8% and of deaths without ESKD 16% among patients with eGFR ≥30 mL/min/1.73 m2 and 37% and 19% for eGFR <30 mL/min/1.73 m2. Adjusted models showed higher risks of ESKD or death for patients with worse kidney function at baseline, male sex, diabetes and higher blood pressure; a higher risk of ESKD with higher albuminuria; and a higher risk of death with older age or cardiovascular comorbidity. CONCLUSIONS: Routine nephrology care of patients in Germany comprises mostly elderly patients, many with slow CKD progression. Identification of risk factors for CKD progression and mortality may help guide resources by closer follow-up of high-risk patients.
Authors: Mathias Gorski; Bettina Jung; Yong Li; Pamela R Matias-Garcia; Matthias Wuttke; Stefan Coassin; Chris H L Thio; Marcus E Kleber; Thomas W Winkler; Veronika Wanner; Jin-Fang Chai; Audrey Y Chu; Massimiliano Cocca; Mary F Feitosa; Sahar Ghasemi; Anselm Hoppmann; Katrin Horn; Man Li; Teresa Nutile; Markus Scholz; Karsten B Sieber; Alexander Teumer; Adrienne Tin; Judy Wang; Bamidele O Tayo; Tarunveer S Ahluwalia; Peter Almgren; Stephan J L Bakker; Bernhard Banas; Nisha Bansal; Mary L Biggs; Eric Boerwinkle; Erwin P Bottinger; Hermann Brenner; Robert J Carroll; John Chalmers; Miao-Li Chee; Miao-Ling Chee; Ching-Yu Cheng; Josef Coresh; Martin H de Borst; Frauke Degenhardt; Kai-Uwe Eckardt; Karlhans Endlich; Andre Franke; Sandra Freitag-Wolf; Piyush Gampawar; Ron T Gansevoort; Mohsen Ghanbari; Christian Gieger; Pavel Hamet; Kevin Ho; Edith Hofer; Bernd Holleczek; Valencia Hui Xian Foo; Nina Hutri-Kähönen; Shih-Jen Hwang; M Arfan Ikram; Navya Shilpa Josyula; Mika Kähönen; Chiea-Chuen Khor; Wolfgang Koenig; Holly Kramer; Bernhard K Krämer; Brigitte Kühnel; Leslie A Lange; Terho Lehtimäki; Wolfgang Lieb; Ruth J F Loos; Mary Ann Lukas; Leo-Pekka Lyytikäinen; Christa Meisinger; Thomas Meitinger; Olle Melander; Yuri Milaneschi; Pashupati P Mishra; Nina Mononen; Josyf C Mychaleckyj; Girish N Nadkarni; Matthias Nauck; Kjell Nikus; Boting Ning; Ilja M Nolte; Michelle L O'Donoghue; Marju Orho-Melander; Sarah A Pendergrass; Brenda W J H Penninx; Michael H Preuss; Bruce M Psaty; Laura M Raffield; Olli T Raitakari; Rainer Rettig; Myriam Rheinberger; Kenneth M Rice; Alexander R Rosenkranz; Peter Rossing; Jerome I Rotter; Charumathi Sabanayagam; Helena Schmidt; Reinhold Schmidt; Ben Schöttker; Christina-Alexandra Schulz; Sanaz Sedaghat; Christian M Shaffer; Konstantin Strauch; Silke Szymczak; Kent D Taylor; Johanne Tremblay; Layal Chaker; Pim van der Harst; Peter J van der Most; Niek Verweij; Uwe Völker; Melanie Waldenberger; Lars Wallentin; Dawn M Waterworth; Harvey D White; James G Wilson; Tien-Yin Wong; Mark Woodward; Qiong Yang; Masayuki Yasuda; Laura M Yerges-Armstrong; Yan Zhang; Harold Snieder; Christoph Wanner; Carsten A Böger; Anna Köttgen; Florian Kronenberg; Cristian Pattaro; Iris M Heid Journal: Kidney Int Date: 2020-10-31 Impact factor: 18.998
Authors: Jarcy Zee; Daniel Muenz; Keith P McCullough; Brian Bieber; Marie Metzger; Natalia Alencar de Pinho; Antonio A Lopes; Danilo Fliser; Bruce M Robinson; Eric Young; Ronald L Pisoni; Bénédicte Stengel; Roberto Pecoits-Filho Journal: Kidney Med Date: 2021-12-11