Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up

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Abstract

Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.

Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.

Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44% were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95% CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95% CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.

Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.

Original languageEnglish
Pages (from-to)333-341
Number of pages9
JournalNephrology Dialysis Transplantation
Volume29
Issue number2
Early online date29 Sep 2013
DOIs
Publication statusPublished - Feb 2014

Keywords

  • chronic kidney disease
  • cohort
  • progression
  • renal replacement therapy
  • risk-factors
  • CKD
  • epidemiology
  • outcomes
  • decline
  • cost
  • care
  • GFR
  • Glomerular Filtration Rate
  • renal insufficiency, chronic

Cite this

@article{341d247adab445f4847d83e31ab3c550,
title = "Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up",
abstract = "Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44{\%} were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95{\%} CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95{\%} CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.",
keywords = "chronic kidney disease, cohort, progression, renal replacement therapy, risk-factors, CKD, epidemiology, outcomes, decline, cost, care , GFR, Glomerular Filtration Rate, renal insufficiency, chronic",
author = "Angharad Marks and Nicholas Fluck and Prescott, {Gordon J.} and Robertson, {Lynn Marie} and Simpson, {William G.} and Smith, {William Cairns S.} and Corri Black",
year = "2014",
month = "2",
doi = "10.1093/ndt/gft393",
language = "English",
volume = "29",
pages = "333--341",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "OXFORD UNIV PRESS",
number = "2",

}

TY - JOUR

T1 - Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up

AU - Marks, Angharad

AU - Fluck, Nicholas

AU - Prescott, Gordon J.

AU - Robertson, Lynn Marie

AU - Simpson, William G.

AU - Smith, William Cairns S.

AU - Black, Corri

PY - 2014/2

Y1 - 2014/2

N2 - Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44% were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95% CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95% CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.

AB - Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44% were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95% CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95% CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.

KW - chronic kidney disease

KW - cohort

KW - progression

KW - renal replacement therapy

KW - risk-factors

KW - CKD

KW - epidemiology

KW - outcomes

KW - decline

KW - cost

KW - care

KW - GFR

KW - Glomerular Filtration Rate

KW - renal insufficiency, chronic

U2 - 10.1093/ndt/gft393

DO - 10.1093/ndt/gft393

M3 - Article

VL - 29

SP - 333

EP - 341

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 2

ER -