Translating chronic kidney disease epidemiology into patient care

the individual/public health risk paradox

Angharad Marks* (Corresponding Author), Corri Black, Nicholas Fluck, William Cairns S Smith, Gordon J Prescott, Laura E Clark, Tariq Z Ali, William G Simpson, Alison M Macleod

*Corresponding author for this work

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Abstract

Background. Applying the Kidney Disease Outcomes Quality Initiative definitions of chronic kidney disease (CKD), it appears that CKD is common. The increased recognition of CKD has brought with it the clinical challenge of translating into practice the implications for the patient and for service planning. To understand the clinical relevance and translate that into information to support individual patient care and service planning, we explored clinical outcomes in a large British CKD cohort, identified through routine opportunistic testing, with a 6-year follow-up (similar to 13 000 patient-years).

Methods. A cohort had previously been identified with CKD-sustained reduced eGFR over at least 3 months and case note review. Six-year (13 339 patient-years) follow-up for renal replacement therapy (RRT) initiation and death was achieved through data linkage. Age- and sex-specific mortality rates were compared to the general population.

Results. Of 3414 individuals (most Stage 3b-5), median age 78.6 years, followed for 13 339 patient-years, 170 (5%) initiated RRT and 2024 (59%) died without initiating RRT. RRT initiation rates decreased with age from 14.33 to 0.65 per 100 patient-years among those aged 15-25 and 75-85 years at baseline but the actual numbers initiating RRT increased from 6 to 34, respectively. RRT initiation rates were lower for female sex, absence of macroalbuminuria and less advanced CKD stage. Mortality rates increased with age from 2 to 34 per 100 patient-years for those aged 15-45 and > 85 years at baseline, an excess of 2 and 17 per 100 patient-years over that of the general population, respectively. However, the increase in relative risk was 19-fold for those aged 15-45 years and just 2-fold in those > 85 years. These data have been converted into simple tools for considering individual patients' risk and informing service planning.

Conclusions. The contrast between relative and absolute risk for both RRT initiation and mortality by age group illustrates the difficulties for planning services. The challenge that now faces clinicians is how to appropriately identify which elderly patients with CKD are at high risk of poor outcome.

Original languageEnglish
Pages (from-to)iii65-iii72
Number of pages8
JournalNephrology Dialysis Transplantation
Volume27
Issue numberSuppl. 3
Early online date24 Apr 2012
DOIs
Publication statusPublished - Oct 2012

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Chronic Renal Insufficiency
Renal Replacement Therapy
Patient Care
Epidemiology
Public Health
Mortality
Patient Care Planning
Information Storage and Retrieval
Kidney Diseases
Population
Age Groups

Keywords

  • chronic kidney disease
  • epidemiology and outcomes
  • mortality
  • renal progression
  • risk communication
  • glomerular-filtration-rate
  • renal replacement therapy
  • cardiovascular mortality
  • general-population
  • albuminuria
  • outcomes
  • CKD
  • proteinuria
  • association
  • progression

Cite this

@article{4908523ad3fd408192949559a5bcad0a,
title = "Translating chronic kidney disease epidemiology into patient care: the individual/public health risk paradox",
abstract = "Background. Applying the Kidney Disease Outcomes Quality Initiative definitions of chronic kidney disease (CKD), it appears that CKD is common. The increased recognition of CKD has brought with it the clinical challenge of translating into practice the implications for the patient and for service planning. To understand the clinical relevance and translate that into information to support individual patient care and service planning, we explored clinical outcomes in a large British CKD cohort, identified through routine opportunistic testing, with a 6-year follow-up (similar to 13 000 patient-years).Methods. A cohort had previously been identified with CKD-sustained reduced eGFR over at least 3 months and case note review. Six-year (13 339 patient-years) follow-up for renal replacement therapy (RRT) initiation and death was achieved through data linkage. Age- and sex-specific mortality rates were compared to the general population.Results. Of 3414 individuals (most Stage 3b-5), median age 78.6 years, followed for 13 339 patient-years, 170 (5{\%}) initiated RRT and 2024 (59{\%}) died without initiating RRT. RRT initiation rates decreased with age from 14.33 to 0.65 per 100 patient-years among those aged 15-25 and 75-85 years at baseline but the actual numbers initiating RRT increased from 6 to 34, respectively. RRT initiation rates were lower for female sex, absence of macroalbuminuria and less advanced CKD stage. Mortality rates increased with age from 2 to 34 per 100 patient-years for those aged 15-45 and > 85 years at baseline, an excess of 2 and 17 per 100 patient-years over that of the general population, respectively. However, the increase in relative risk was 19-fold for those aged 15-45 years and just 2-fold in those > 85 years. These data have been converted into simple tools for considering individual patients' risk and informing service planning.Conclusions. The contrast between relative and absolute risk for both RRT initiation and mortality by age group illustrates the difficulties for planning services. The challenge that now faces clinicians is how to appropriately identify which elderly patients with CKD are at high risk of poor outcome.",
keywords = "chronic kidney disease, epidemiology and outcomes, mortality, renal progression, risk communication, glomerular-filtration-rate, renal replacement therapy, cardiovascular mortality, general-population, albuminuria, outcomes, CKD, proteinuria, association, progression",
author = "Angharad Marks and Corri Black and Nicholas Fluck and Smith, {William Cairns S} and Prescott, {Gordon J} and Clark, {Laura E} and Ali, {Tariq Z} and Simpson, {William G} and Macleod, {Alison M}",
year = "2012",
month = "10",
doi = "10.1093/ndt/gfr746",
language = "English",
volume = "27",
pages = "iii65--iii72",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "OXFORD UNIV PRESS",
number = "Suppl. 3",

}

TY - JOUR

T1 - Translating chronic kidney disease epidemiology into patient care

T2 - the individual/public health risk paradox

AU - Marks, Angharad

AU - Black, Corri

AU - Fluck, Nicholas

AU - Smith, William Cairns S

AU - Prescott, Gordon J

AU - Clark, Laura E

AU - Ali, Tariq Z

AU - Simpson, William G

AU - Macleod, Alison M

PY - 2012/10

Y1 - 2012/10

N2 - Background. Applying the Kidney Disease Outcomes Quality Initiative definitions of chronic kidney disease (CKD), it appears that CKD is common. The increased recognition of CKD has brought with it the clinical challenge of translating into practice the implications for the patient and for service planning. To understand the clinical relevance and translate that into information to support individual patient care and service planning, we explored clinical outcomes in a large British CKD cohort, identified through routine opportunistic testing, with a 6-year follow-up (similar to 13 000 patient-years).Methods. A cohort had previously been identified with CKD-sustained reduced eGFR over at least 3 months and case note review. Six-year (13 339 patient-years) follow-up for renal replacement therapy (RRT) initiation and death was achieved through data linkage. Age- and sex-specific mortality rates were compared to the general population.Results. Of 3414 individuals (most Stage 3b-5), median age 78.6 years, followed for 13 339 patient-years, 170 (5%) initiated RRT and 2024 (59%) died without initiating RRT. RRT initiation rates decreased with age from 14.33 to 0.65 per 100 patient-years among those aged 15-25 and 75-85 years at baseline but the actual numbers initiating RRT increased from 6 to 34, respectively. RRT initiation rates were lower for female sex, absence of macroalbuminuria and less advanced CKD stage. Mortality rates increased with age from 2 to 34 per 100 patient-years for those aged 15-45 and > 85 years at baseline, an excess of 2 and 17 per 100 patient-years over that of the general population, respectively. However, the increase in relative risk was 19-fold for those aged 15-45 years and just 2-fold in those > 85 years. These data have been converted into simple tools for considering individual patients' risk and informing service planning.Conclusions. The contrast between relative and absolute risk for both RRT initiation and mortality by age group illustrates the difficulties for planning services. The challenge that now faces clinicians is how to appropriately identify which elderly patients with CKD are at high risk of poor outcome.

AB - Background. Applying the Kidney Disease Outcomes Quality Initiative definitions of chronic kidney disease (CKD), it appears that CKD is common. The increased recognition of CKD has brought with it the clinical challenge of translating into practice the implications for the patient and for service planning. To understand the clinical relevance and translate that into information to support individual patient care and service planning, we explored clinical outcomes in a large British CKD cohort, identified through routine opportunistic testing, with a 6-year follow-up (similar to 13 000 patient-years).Methods. A cohort had previously been identified with CKD-sustained reduced eGFR over at least 3 months and case note review. Six-year (13 339 patient-years) follow-up for renal replacement therapy (RRT) initiation and death was achieved through data linkage. Age- and sex-specific mortality rates were compared to the general population.Results. Of 3414 individuals (most Stage 3b-5), median age 78.6 years, followed for 13 339 patient-years, 170 (5%) initiated RRT and 2024 (59%) died without initiating RRT. RRT initiation rates decreased with age from 14.33 to 0.65 per 100 patient-years among those aged 15-25 and 75-85 years at baseline but the actual numbers initiating RRT increased from 6 to 34, respectively. RRT initiation rates were lower for female sex, absence of macroalbuminuria and less advanced CKD stage. Mortality rates increased with age from 2 to 34 per 100 patient-years for those aged 15-45 and > 85 years at baseline, an excess of 2 and 17 per 100 patient-years over that of the general population, respectively. However, the increase in relative risk was 19-fold for those aged 15-45 years and just 2-fold in those > 85 years. These data have been converted into simple tools for considering individual patients' risk and informing service planning.Conclusions. The contrast between relative and absolute risk for both RRT initiation and mortality by age group illustrates the difficulties for planning services. The challenge that now faces clinicians is how to appropriately identify which elderly patients with CKD are at high risk of poor outcome.

KW - chronic kidney disease

KW - epidemiology and outcomes

KW - mortality

KW - renal progression

KW - risk communication

KW - glomerular-filtration-rate

KW - renal replacement therapy

KW - cardiovascular mortality

KW - general-population

KW - albuminuria

KW - outcomes

KW - CKD

KW - proteinuria

KW - association

KW - progression

U2 - 10.1093/ndt/gfr746

DO - 10.1093/ndt/gfr746

M3 - Article

VL - 27

SP - iii65-iii72

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - Suppl. 3

ER -