Does stage-3 chronic kidney disease matter? A systematic literature review

Pawana Sharma, Keith McCullough, Graham Scotland, Paul McNamee, Gordon Prescott, Alison Macleod, Nick Fluck, William Cairns Smith, Corri Black

Research output: Contribution to journalLiterature review

7 Citations (Scopus)

Abstract

Background

Stage-3 chronic kidney disease (CKD) is the first stage that is identifiable from a blood test alone. In the UK, it accounts for the majority of people on primary care CKD registers. It also represents a group of People who, in the past, would have gone unnoticed clinically. In order to support patients and plan services, the natural history of stage-3 CKD is important.

Aim

To systematically review the natural history of stage-3 CKD in order to describe all cause mortality, cardiovascular morbidity and mortality, and renal outcomes.

Design of study

Systematic review of the literature.

Method

MEDLINE and Embase databases were searched from 1998 to February 2009. Systematic reviews and cohort studies that included adults with stage-3 CKD were considered eligible. Studies were appraised and data extracted by one reviewer and checked by a second.

Results

Thirteen studies were identified including a total of 728 328 people. The all-cause mortality rate varied from 6% in 3 years to 51% in 10 years and was higher in stage-3B CKD (4.8 per 100 person-years) than stage-3A CKD (1.1 per 100 person-years). The relative risk of mortality (all-cause mortality or cardiovascular disease [CVD] mortality) was higher in stage-3 CKD compared with no CKD, but the increase was small for those with stage-3A CKD (hazard ratio [HR] 1.2-1.7) and greater in stage 3B (HR 1.8-3.3). End-stage renal disease was rare (4% in 10 years) and renal progression was evident in <20% of patients after 5 years.

Conclusions

For patients with stage-3 CKD, risk of mortality was higher than for those without CKD, but the risk of progression was low. CKD registers provide an opportunity for GPs to assess the risk of patients developing CVD.

Original languageEnglish
Pages (from-to)e266-e276
Number of pages11
JournalThe British Journal of General Practice
Volume60
Issue number575
DOIs
Publication statusPublished - 1 Jun 2010

Keywords

  • chronic kidney disease
  • natural history
  • primary care
  • systematic review
  • glomerular-filtration-rate
  • general-population
  • renal-disease
  • United-States
  • risk-factors
  • follow-up
  • progression
  • prevalence
  • mortality
  • CKD

Cite this

Does stage-3 chronic kidney disease matter? A systematic literature review. / Sharma, Pawana; McCullough, Keith; Scotland, Graham; McNamee, Paul; Prescott, Gordon; Macleod, Alison; Fluck, Nick; Smith, William Cairns; Black, Corri.

In: The British Journal of General Practice, Vol. 60, No. 575, 01.06.2010, p. e266-e276.

Research output: Contribution to journalLiterature review

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title = "Does stage-3 chronic kidney disease matter?: A systematic literature review",
abstract = "BackgroundStage-3 chronic kidney disease (CKD) is the first stage that is identifiable from a blood test alone. In the UK, it accounts for the majority of people on primary care CKD registers. It also represents a group of People who, in the past, would have gone unnoticed clinically. In order to support patients and plan services, the natural history of stage-3 CKD is important.AimTo systematically review the natural history of stage-3 CKD in order to describe all cause mortality, cardiovascular morbidity and mortality, and renal outcomes.Design of studySystematic review of the literature.MethodMEDLINE and Embase databases were searched from 1998 to February 2009. Systematic reviews and cohort studies that included adults with stage-3 CKD were considered eligible. Studies were appraised and data extracted by one reviewer and checked by a second.ResultsThirteen studies were identified including a total of 728 328 people. The all-cause mortality rate varied from 6{\%} in 3 years to 51{\%} in 10 years and was higher in stage-3B CKD (4.8 per 100 person-years) than stage-3A CKD (1.1 per 100 person-years). The relative risk of mortality (all-cause mortality or cardiovascular disease [CVD] mortality) was higher in stage-3 CKD compared with no CKD, but the increase was small for those with stage-3A CKD (hazard ratio [HR] 1.2-1.7) and greater in stage 3B (HR 1.8-3.3). End-stage renal disease was rare (4{\%} in 10 years) and renal progression was evident in <20{\%} of patients after 5 years.ConclusionsFor patients with stage-3 CKD, risk of mortality was higher than for those without CKD, but the risk of progression was low. CKD registers provide an opportunity for GPs to assess the risk of patients developing CVD.",
keywords = "chronic kidney disease, natural history, primary care, systematic review, glomerular-filtration-rate, general-population, renal-disease, United-States, risk-factors, follow-up, progression, prevalence, mortality, CKD",
author = "Pawana Sharma and Keith McCullough and Graham Scotland and Paul McNamee and Gordon Prescott and Alison Macleod and Nick Fluck and Smith, {William Cairns} and Corri Black",
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T1 - Does stage-3 chronic kidney disease matter?

T2 - A systematic literature review

AU - Sharma, Pawana

AU - McCullough, Keith

AU - Scotland, Graham

AU - McNamee, Paul

AU - Prescott, Gordon

AU - Macleod, Alison

AU - Fluck, Nick

AU - Smith, William Cairns

AU - Black, Corri

PY - 2010/6/1

Y1 - 2010/6/1

N2 - BackgroundStage-3 chronic kidney disease (CKD) is the first stage that is identifiable from a blood test alone. In the UK, it accounts for the majority of people on primary care CKD registers. It also represents a group of People who, in the past, would have gone unnoticed clinically. In order to support patients and plan services, the natural history of stage-3 CKD is important.AimTo systematically review the natural history of stage-3 CKD in order to describe all cause mortality, cardiovascular morbidity and mortality, and renal outcomes.Design of studySystematic review of the literature.MethodMEDLINE and Embase databases were searched from 1998 to February 2009. Systematic reviews and cohort studies that included adults with stage-3 CKD were considered eligible. Studies were appraised and data extracted by one reviewer and checked by a second.ResultsThirteen studies were identified including a total of 728 328 people. The all-cause mortality rate varied from 6% in 3 years to 51% in 10 years and was higher in stage-3B CKD (4.8 per 100 person-years) than stage-3A CKD (1.1 per 100 person-years). The relative risk of mortality (all-cause mortality or cardiovascular disease [CVD] mortality) was higher in stage-3 CKD compared with no CKD, but the increase was small for those with stage-3A CKD (hazard ratio [HR] 1.2-1.7) and greater in stage 3B (HR 1.8-3.3). End-stage renal disease was rare (4% in 10 years) and renal progression was evident in <20% of patients after 5 years.ConclusionsFor patients with stage-3 CKD, risk of mortality was higher than for those without CKD, but the risk of progression was low. CKD registers provide an opportunity for GPs to assess the risk of patients developing CVD.

AB - BackgroundStage-3 chronic kidney disease (CKD) is the first stage that is identifiable from a blood test alone. In the UK, it accounts for the majority of people on primary care CKD registers. It also represents a group of People who, in the past, would have gone unnoticed clinically. In order to support patients and plan services, the natural history of stage-3 CKD is important.AimTo systematically review the natural history of stage-3 CKD in order to describe all cause mortality, cardiovascular morbidity and mortality, and renal outcomes.Design of studySystematic review of the literature.MethodMEDLINE and Embase databases were searched from 1998 to February 2009. Systematic reviews and cohort studies that included adults with stage-3 CKD were considered eligible. Studies were appraised and data extracted by one reviewer and checked by a second.ResultsThirteen studies were identified including a total of 728 328 people. The all-cause mortality rate varied from 6% in 3 years to 51% in 10 years and was higher in stage-3B CKD (4.8 per 100 person-years) than stage-3A CKD (1.1 per 100 person-years). The relative risk of mortality (all-cause mortality or cardiovascular disease [CVD] mortality) was higher in stage-3 CKD compared with no CKD, but the increase was small for those with stage-3A CKD (hazard ratio [HR] 1.2-1.7) and greater in stage 3B (HR 1.8-3.3). End-stage renal disease was rare (4% in 10 years) and renal progression was evident in <20% of patients after 5 years.ConclusionsFor patients with stage-3 CKD, risk of mortality was higher than for those without CKD, but the risk of progression was low. CKD registers provide an opportunity for GPs to assess the risk of patients developing CVD.

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KW - natural history

KW - primary care

KW - systematic review

KW - glomerular-filtration-rate

KW - general-population

KW - renal-disease

KW - United-States

KW - risk-factors

KW - follow-up

KW - progression

KW - prevalence

KW - mortality

KW - CKD

U2 - 10.3399/bjgp10X502173

DO - 10.3399/bjgp10X502173

M3 - Literature review

VL - 60

SP - e266-e276

JO - The British Journal of General Practice

JF - The British Journal of General Practice

SN - 0960-1643

IS - 575

ER -