The Natural History of Chronic Renal Failure: Results From an Unselected, Population-Based, Inception Cohort in Sweden

Evans, Marie; Fryzek, Jon P.; Elinder, Carl‐Gustaf; Cohen, Sarah S.; McLaughlin, Joseph K.; Nyrén, Olof; Fored, C. Michael

doi:10.1053/j.ajkd.2005.07.040

Cited by 139 publications

(115 citation statements)

References 21 publications

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“…In younger cohort members, rates of ESRD exceeded those of death among patients with severe reductions in eGFR and in some with moderate reductions. This observation is broadly consistent with other studies showing that the rate of progression of CKD may decrease with advancing age 11,[21][22][23] and is often slow in older patients. 24,25 With the future prospect of more widespread eGFRbased screening for CKD in the primary care setting, 3,26 it is critical that providers understand how the clinical implications of eGFR vary by age and that practice guidelines address this variation.…”

Section: Discussionsupporting

confidence: 81%

Age Affects Outcomes in Chronic Kidney Disease

O’Hare

Choi

Bertenthal

et al. 2007

Journal of the American Society of Nephrology

606

426

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Chronic kidney disease (CKD) is common among the elderly. However, little is known about how the clinical implications of CKD vary with age. We examined the age-specific incidence of death, treated end-stage renal disease (ESRD), and change in estimated glomerular filtration rate (eGFR) among 209,622 US veterans with CKD stages 3 to 5 followed for a mean of 3.2 years. Patients aged 75 years or older at baseline comprised 47% of the overall cohort and accounted for 28% of the 9227 cases of ESRD that occurred during follow-up. Among patients of all ages, rates of both death and ESRD were inversely related to eGFR at baseline. However, among those with comparable levels of eGFR, older patients had higher rates of death and lower rates of ESRD than younger patients. Consequently, the level of eGFR below which the risk of ESRD exceeded the risk of death varied by age, ranging from 45 ml/min per 1.73 m 2 for 18 to 44 year old patients to 15 ml/min per 1.73 m 2 for 65 to 84 year old patients. Among those 85 years or older, the risk of death always exceeded the risk of ESRD in this cohort. Among patients with eGFR levels Ͻ45 ml/min per 1.73 m 2 at baseline, older patients were less likely than their younger counterparts to experience an annual decline in eGFR of Ͼ3 ml/min per 1.73 m 2 . In conclusion, age is a major effect modifier among patients with an eGFR of Ͻ60 ml/min per 1.73 m 2 , challenging us to move beyond a uniform stage-based approach to managing CKD. 18: 275818: -276518: , 200718: . doi: 10.1681 Chronic kidney disease (CKD) is common in the elderly, 1,2 leading some professional organizations to recommend routine age-based screening for CKD in the primary care setting 3 ; however, relatively little is known about the clinical course of CKD in older individuals. Most previous studies of CKD and current recommendations for its management have not distinguished between patients of different ages, and efforts to identify risk factors for progression of CKD have generally focused on patient characteristics other than age. 4 -17 We hypothesized that the frequency of clinically significant outcomes among patients who meet National Kidney Foundation criteria for stages 3 to 5 CKD would differ substantially across age groups. We tested this hypothesis among a national cohort J Am Soc Nephrol

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Section: Discussionsupporting

confidence: 81%

Age Affects Outcomes in Chronic Kidney Disease

O’Hare

Choi

Bertenthal

et al. 2007

Journal of the American Society of Nephrology

606

426

View full text Add to dashboard Cite

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“…100 Also, the severity of kidney disease may affect the association between BMI and outcome. In accordance with the findings in the hemodialysis population, Evans et al 101 and Kovesdy et al 102 reported that a high BMI was protective in CKD stages 3-5 patients. However, Madero et al 103 and Weiner et al 104 reported that high BMI had no protective effect in CKD stages 3 and 4 patients.…”

Section: Should Nephrologists Promote Weight Gain In Dialysis Patients?supporting

confidence: 70%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

193

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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“…Two prior studies have also described the obesity paradox in patients with advanced CKD (17,18). Our study extends these observations by showing that the obesity paradox is also present among adults residing in nursing homes and highlights the association of weight loss Pre-ESRD weight and body mass index (BMI) were measured at a median of 4.7 months before dialysis initiation.…”

Section: Discussionsupporting

confidence: 70%

Pre-ESRD Changes in Body Weight and Survival in Nursing Home Residents Starting Dialysis

Stack

Chertow

Johansen

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Among patients receiving maintenance dialysis, weight loss at any body mass index is associated with mortality. However, it is not known whether weight changes before dialysis initiation are associated with mortality and if so, what risks are associated with weight gain or loss.Design, setting, participants, and measurements Linking data from the US Renal Data System to a national registry of nursing home residents, this study identified 11,090 patients who started dialysis between January of 2000 and December of 2006. Patients were categorized according to weight measured between 3 and 6 months before dialysis initiation and the percentage change in body weight before dialysis initiation (divided into quintiles). The outcome was mortality within 1 year of starting dialysis.Results There were 361 patients (3.3%) who were underweight (Quételet's [body mass] index,18.5 kg/m 2 ) and 4046 patients (36.5%) who were obese (body mass index$30 kg/m 2 ) before dialysis initiation. The median percentage change in body weight before dialysis initiation was 26% (interquartile range=213% to 1%). There were 6063 deaths (54.7%) over 1 year of follow-up. Compared with patients with minimal weight changes (23% to 3%, quintile 4), patients with weight loss $15% (quintile 1) had 35% higher risk for mortality (95% confidence interval, 1.25 to 1.47), whereas those patients with weight gain$4% (quintile 5) had a 24% higher risk for mortality (95% confidence interval, 1.14 to 1.35) adjusted for baseline body mass index and other confounders.Conclusions Among nursing home residents, changes in body weight in advance of dialysis initiation are associated with significantly higher 1-year mortality.

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The Natural History of Chronic Renal Failure: Results From an Unselected, Population-Based, Inception Cohort in Sweden

Cited by 139 publications

References 21 publications

Age Affects Outcomes in Chronic Kidney Disease

Age Affects Outcomes in Chronic Kidney Disease

Obesity in CKD—What Should Nephrologists Know?

Pre-ESRD Changes in Body Weight and Survival in Nursing Home Residents Starting Dialysis

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