Risks of Adverse Events in Advanced CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study

Abstract

Background People with advanced chronic kidney disease (CKD) are at risk for the development of end-stage renal disease (ESRD), but also many other adverse outcomes, including cardiovascular disease (CVD) events and death. Determination of risk factors that explain the variability in prognosis and timing of these adverse outcomes can aid patient counseling and medical decision-making. Study Design Prospective research cohort. Setting & Participants 1,798 participants with eGFR <30 ml/min/1.73 m2 in the CRIC Study were followed up for a median of 5.5 years. Predictors Age, race, sex, eGFR, proteinuria, diabetes mellitus, body mass index, ejection fraction, systolic blood pressure, history of cardiovascular disease, and history. Outcomes ESRD, CVD (congestive heart failure, stroke, myocardial infarction, peripheral artery disease), and death. Results Baseline age of the cohort was 60 years; 46% were women, and 46% were African American. While 52.3% of participants progressed to ESRD during follow-up, the path by which this occurred was variable. For example, the predicted 1-year probabilities for a hypothetical 60-year-old white woman with eGFR 30 ml/min/1.73 m2, 1.8 g/d of proteinuria, and no diabetes or CVD (risk characteristics similar to the average participant), were 3.3%, 4.1%, and 0.3%, for first developing CVD, ESRD, and death, respectively. For a 40-year-old African-American man with similar characteristics but higher systolic blood pressure, the corresponding 1-year probabilities were 2.4%, 13.2%, and 0.1%. For all participants, the development of ESRD or CVD increased the risk of subsequent mortality, with no differences by patient race or body-mass index. Limitations The CRIC population was specifically recruited for kidney disease, and the vast majority had seen a nephrologist. Conclusions The prognosis and timing of adverse outcomes in CKD varies by patient characteristics. These results may help guide the development of personalized approaches for managing patients with advanced CKD.

Influence of Sex on the Progression of Chronic Kidney Disease

“…Among nearly 8000 patients with stage 5 CKD not undergoing dialysis followed up for a mean of 11 months, men were more likely than women to die without initiating dialysis in adjusted analysis; however, in unadjusted analysis, the opposite was true. 114 Evans et al 21 performed a patient-level meta-analysis of 28 cohorts containing over 185,000 patients with stage 4 or 5 CKD and found that, in adjusted analysis, men were more likely to die without renal replacement therapy than women. Conflicting results have been reported from several smaller studies that examined survival in late stage CKD without dialysis.…”

Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric Glomerulopathies

“…We demonstrate that adult hypertensive BP status is associated both with the development of ESRD and with a decline in eGFR of 40% or more. Data from the Chronic Renal Insufficiency Cohort (CRIC) supports that hypertension is associated with progression of renal disease and ESRD, however the cohort includes various etiologies of kidney disease 27 . The scant reports on primary gomerulopathies are conflicting.…”

Patterns and characteristics of cognitive functioning in older patients approaching end stage kidney disease, the COPE-study

“…Older patients approaching end stage kidney disease (ESKD) have, compared to younger patients, an increased risk for adverse health outcomes in general [1] and for impaired cognitive functioning [2], with a high prevalence ranging from 30 to 87% in dialysis patients [3,4]. Cognitive impairment has a major impact on outcomes in (older) patients receiving renal replacement therapy (RRT) [5].…”