The natural history of, and risk factors for, progressive Chronic Kidney Disease (CKD): the Renal Impairment in Secondary care (RIISC) study; rationale and protocol

Stringer, Stephanie; Sharma, Praveen; Dutton, Mary Ann; Jesky, Mark; Ng, Khai Ping; Kaur, Okdeep; Chapple, Iain; Dietrich, Thomas; Ferro, Charles J.; Cockwell, Paul

doi:10.1186/1471-2369-14-95

Cited by 39 publications

(42 citation statements)

References 149 publications

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“…Ongoing longitudinal studies (Stringer et al. ) investigating large cohorts of patients with pre‐dialysis CKD may provide confirmation of this association and shed light upon explanatory mechanisms. Successful treatment of periodontitis has been shown to improve surrogate markers of CVD risk, including serum markers of systemic inflammation (CRP, IL‐6) (D'Aiuto et al.…”

Section: Discussionmentioning

confidence: 89%

Association between periodontitis and mortality in stages 3–5 chronic kidney disease: NHANES III and linked mortality study

Sharma

Dietrich

Ferro

et al. 2016

J Clinic Periodontology

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125

104

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IntroductionPeriodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all‐cause and cardiovascular disease‐related) in individuals with stage 3–5 CKD, hitherto referred to as “CKD”.MethodsSurvival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking).ResultsOf the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow‐up for this cohort was 14.3 years. Adjusting for confounders, the 10‐year all‐cause mortality rate for individuals with CKD increased from 32% (95% CI: 29–35%) to 41% (36–47%) with the addition of periodontitis. For diabetes, the 10‐year all‐cause mortality rate increased to 43% (38–49%).ConclusionThere is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD.

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Section: Discussionmentioning

confidence: 89%

Association between periodontitis and mortality in stages 3–5 chronic kidney disease: NHANES III and linked mortality study

Sharma

Dietrich

Ferro

et al. 2016

J Clinic Periodontology

Self Cite

125

104

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“…The RIISC study is a prospective observational cohort study designed to identify determinants of adverse outcomes in CKD, and detailed methodology has previously been described [13]. …”

Section: Methodsmentioning

confidence: 99%

Serum endotrophin, a type VI collagen cleavage product, is associated with increased mortality in chronic kidney disease

et al. 2017

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BackgroundPatients with chronic kidney disease (CKD) are at increased risk of end-stage renal disease (ESRD) and early mortality. The underlying pathophysiological processes are not entirely understood but may include dysregulation of extracellular matrix formation with accelerated systemic and renal fibrosis. We assessed the relationship between endotrophin (ETP), a marker of collagen type VI formation, and adverse outcomes in a cohort of patients with CKD.MethodsWe measured serum ETP levels in 500 patients from the Renal Impairment in Secondary Care (RIISC) study, a prospective observational study of patients with high-risk CKD. Patients were followed up until death or progression to ESRD. Cox regression analysis was used to assess the relationship between ETP and risk of adverse outcomes.ResultsDuring a median follow-up time of 37 months, 104 participants progressed to ESRD and 66 died. ETP level was significantly associated with progression to ESRD (HR 1.79 [95% CI 1.59–2.02] per 10 ng/mL increase; HR 11.05 [4.98–24.52] for highest vs lowest quartile; both P<0.0001). ETP level was also significantly associated with mortality (HR 1.60 [1.35–1.89] per 10 ng/mL increase; HR 12.14 [4.26–34.54] for highest vs lowest quartile; both P<0.0001). After adjustment for confounding variables, ETP was no longer significantly associated with progression to ESRD but remained independently associated with mortality (HR 1.51 [1.07–2.12] per 10 ng/mL increase, P = 0.019).ConclusionsSerum ETP level is independently associated with mortality in CKD. This study provides the basis for further exploratory work to establish whether collagen type VI formation is mechanistically involved in the increased mortality risk associated with CKD.

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“…Patient recruitment commenced in October 2010, the methodology utilised has been described in detail elsewhere [14, 15]. …”

Section: Methodsmentioning

confidence: 99%

“…Blood and urine samples were collected and processed according to pre-defined standard operating procedures and stored at -80°C until analysis [14]. Patient mortality was captured through linkage between electronic patient records and the Office of National Statistics, which collects information on all registered deaths in the United Kingdom.…”

Section: Methodsmentioning

confidence: 99%

Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study

et al. 2016

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BackgroundChronic kidney disease (CKD) is associated with reduced health-related quality of life (HRQL). However, the relationship between pre-dialysis CKD, HRQL and clinical outcomes, including mortality and progression to end-stage renal disease (ESRD) is unclear.MethodsAll 745 participants recruited into the Renal Impairment In Secondary Care study to end March 2014 were included. Demographic, clinical and laboratory data were collected at baseline including an assessment of HRQL using the Euroqol EQ-5D-3L. Health states were converted into an EQ-5Dindex score using a set of weighted preferences specific to the UK population. Multivariable Cox proportional hazards regression and competing risk analyses were undertaken to evaluate the association of HRQL with progression to ESRD or all-cause mortality. Regression analyses were then performed to identify variables associated with the significant HRQL components.ResultsMedian eGFR was 25.8 ml/min/1.73 m2 (IQR 19.6–33.7ml/min) and median ACR was 33 mg/mmol (IQR 6.6–130.3 mg/mmol). Five hundred and fifty five participants (75.7%) reported problems with one or more EQ-5D domains. When adjusted for age, gender, comorbidity, eGFR and ACR, both reported problems with self-care [hazard ratio 2.542, 95% confidence interval 1.222–5.286, p = 0.013] and reduced EQ-5Dindex score [hazard ratio 0.283, 95% confidence interval 0.099–0.810, p = 0.019] were significantly associated with an increase in all-cause mortality. Similar findings were observed for competing risk analyses. Reduced HRQL was not a risk factor for progression to ESRD in multivariable analyses.ConclusionsImpaired HRQL is common in the pre-dialysis CKD population. Reduced HRQL, as demonstrated by problems with self-care or a lower EQ-5Dindex score, is associated with a higher risk for death but not ESRD. Multiple factors influence these aspects of HRQL but renal function, as measured by eGFR and ACR, are not among them.

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The natural history of, and risk factors for, progressive Chronic Kidney Disease (CKD): the Renal Impairment in Secondary care (RIISC) study; rationale and protocol

Cited by 39 publications

References 149 publications

Association between periodontitis and mortality in stages 3–5 chronic kidney disease: NHANES III and linked mortality study

Association between periodontitis and mortality in stages 3–5 chronic kidney disease: NHANES III and linked mortality study

Serum endotrophin, a type VI collagen cleavage product, is associated with increased mortality in chronic kidney disease

Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study

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