Kidney Failure and ESRD in the Atherosclerosis Risk in Communities (ARIC) Study: Comparing Ascertainment of Treated and Untreated Kidney Failure in a Cohort Study

Abstract

Background Linkage to the US Renal Data System (USRDS) registry is commonly used to identify end-stage renal disease (ESRD) cases, or kidney failure treated with dialysis or transplantation, but it underestimates the total burden of kidney failure. This study validates a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation. It compares kidney failure risk factors and outcomes using this broader definition to USRDS-identified ESRD risk factors and outcomes. Study Design Diagnostic test study with stratified random sampling of hospitalizations for chart review. Setting & Participants Atherosclerosis Risk in Communities Study (N=11,530; chart review n=546). Index Test USRDS-identified ESRD; treated or untreated kidney failure defined by USRDS-identified ESRD or International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM code from hospitalization or death. Reference Test For ESRD, determination of permanent dialysis or transplantation; for kidney failure, determination of permanent dialysis, transplantation, or eGFR <15 mL/min/1.73 m2. Results Over 13 years' median follow-up, 508 kidney failure cases were identified, including 173 (34.1%) from the USRDS registry. ESRD and kidney failure incidence were 1.23 and 3.66 cases per 1,000 person-years in the overall population, and 1.35 and 6.59 cases per 1,000 person-years among participants older than 70 years, respectively. Other risk factor associations were similar between ESRD and kidney failure, except diabetes and albuminuria which were stronger for ESRD. Survival at 1 and 5 years were 74.0% and 24.0% for ESRD and 59.8% and 31.6% for kidney failure, respectively. Sensitivity and specificity were 88.0% and 97.3% comparing the kidney failure ICD-9-CM/ICD-10-CM code algorithm to chart review; for USRDS-identified ESRD, sensitivity and specificity were 94.9% and 100.0%. Limitations Some medical charts were incomplete. Conclusions A kidney failure definition including treated and untreated disease identifies more cases than linkage to the USRDS registry alone, particularly among older adults. Future studies might consider reporting both USRDS-identified ESRD and a more inclusive kidney failure definition.

Biomarkers of Vitamin D Status and Risk of ESRD

“…Use of hospitalization data has been shown to be a valid method for defining ESRD and is more representative of the overall burden of kidney disease by incorporating treated and untreated kidney disease including deaths due to kidney disease. 40,41 We previously reported that, compared to medical record review, our composite definition including ICD-9/10 codes for hospitalizations has a sensitivity of 88% and specificity of 97%. 41 Assessment of free and bioavailable 25(OH)D was based on calculations rather than direct measurement.…”

Prevalence and recognition of chronic kidney disease in Stockholm healthcare

“…Direct comparison estimates across studies is hampered by differences in study design, data coverage, methodology and reporting. For example, probability samples, such as NHANES or ARIC, require participants to volunteer, inevitably excluding sicker individuals [30]. On the other hand, healthcare utilization cohorts, such as this one, may overestimate CKD estimates since non-users of the health system are excluded.…”

Race, APOL1 Risk, and eGFR Decline in the General Population

“…29 eGFR was calculated using these values and the Chronic Kidney Disease Epidemiology Collaboration equation. 33 Cases of ESRD were determined through linkage to the US Renal Data System registry 34 ; eGFR at the time of ESRD onset was imputed as 15 ml/min per 1.73 m 2 . In sensitivity analysis, we also included eGFR abstracted from intervening cardiovascular hospitalizations.…”