Unreferred chronic kidney disease: a longitudinal study

John, R. Ian; Webb, Michelle; Young, Alan; Stevens, Paul E.

doi:10.1053/j.ajkd.2003.12.046

Cited by 220 publications

(160 citation statements)

References 41 publications

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“…This finding is in line with a recent study in England in individuals with a median eGFR of 28.5 ml/min per 1.73 m 2 . The majority of these individuals had stable renal function over 31 mo (24). An explanation for the unexpected finding of stable renal function in a group of individuals who were selected on the basis of impaired renal function at baseline can be the phenomenon of "regression to the mean."…”

Section: Discussionmentioning

confidence: 99%

Macroalbuminuria Is a Better Risk Marker than Low Estimated GFR to Identify Individuals at Risk for Accelerated GFR Loss in Population Screening

Halbesma

Kuiken²,

Brantsma³

et al. 2006

Journal of the American Society of Nephrology

179

114

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Macroalbuminuria, erythrocyturia, and impaired renal function are strong predictors of poor renal outcome in patients with known renal disease. However, the yield of mass screening for these variables to identify individuals who are at risk for GFR loss is yet unknown in a Western population. With the use of data from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, population-based cohort study, the cardiovascular and renal prognosis was investigated in patients with classical renal risk markers: Macroalbuminuria (>300 mg albumin/24 h urine), erythrocyturia (>250 erythrocytes/L, without leukocyturia), and impaired renal function (both 24-h creatinine clearance and Modification of Diet in Renal Disease clearance below the fifth percentile of age-and gender-matched control subjects). The 8592 patients who were included in this study were followed for a 4-yr period. We identified 134 patients with macroalbuminuria, 128 with erythrocyturia, and 103 with impaired renal function. There was only a little overlap among the three groups. The prevalence of macroalbuminuria, erythrocyturia, and impaired renal function was calculated to be in the general population 0.6, 1.3, and 0.9%, respectively. In all three groups, fewer than 30% of patients were known to have this laboratory abnormality before screening. The incidence of cardiovascular disease was high in the macroalbuminuria group (e.g., the age-and gender-adjusted hazard ratio for mortality as a result of cardiovascular disease is 2.6 [1.1 to 6.0]) and for the impaired renal function group (3.4 [1.5 to 8.0]). After a mean follow-up of 4.2 yr, the macroalbuminuria group showed a ؊7.2 ml/min per 1.73 m 2 estimated GFR (eGFR) loss, compared with ؊2.3 ml/min per 1.73 m 2 in the control group (difference P < 0.001), whereas the rate of eGFR loss in the impaired renal function group (؊0.2 ml/min per 1.73 m 2 ; P ‫؍‬ 0.18) and the erythrocyturia group (؊2.6 ml/min per 1.73 m 2 ) was not different from the control group. Macroalbuminuria and impaired renal function both predict a worse prognosis with respect to cardiovascular morbidity and mortality. However, macroalbuminuria is a better risk marker than low eGFR or erythrocyturia to identify in population screening of individuals who are at risk for accelerated GFR loss.

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Section: Discussionmentioning

confidence: 99%

Macroalbuminuria Is a Better Risk Marker than Low Estimated GFR to Identify Individuals at Risk for Accelerated GFR Loss in Population Screening

Halbesma

Kuiken²,

Brantsma³

et al. 2006

Journal of the American Society of Nephrology

179

114

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“…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. At the same time, any effective management strategy must embrace the reality that, although less likely to develop ESRD than their younger counterparts with similar levels of eGFR, older patients comprise a large and growing percentage (and number) of all new cases of ESRD in the United States.…”

Section: Discussionmentioning

confidence: 99%

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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“…Indeed, although it is known that the risk of adverse outcomes increases when GFR declines below 60 ml/min in the population at large (2,10), to our knowledge, only a single study has evaluated outcomes of patients with CKD who were not referred (11). However, this study focused only on mortality risk without adjustment for clinical comorbidities and albuminuria (11).…”

Section: Introductionmentioning

confidence: 99%

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Minutolo

Lapi

Chiodini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Rising prevalence of CKD requires active involvement of general practitioners to limit ESRD and mortality risk. However, the outcomes of patients with CKD exclusively managed by general practitioners are ill defined. Results Overall 64% of patients were in stage 3a, and 4.5% of patients were in stages 3b-5. Patients with stages 1 and 2 were younger, were predominantly men, more frequently had diabetes, and had lower prevalence of previous cardiovascular disease than patients with stages 3a-5. Hypertension was frequent in all CKD stages (80%-94%), whereas there was a lower prevalence of dyslipidemia, albuminuria, and obesity associated with more advanced CKD. During the follow-up (median=7.2 years; interquartile range=4.7-7.7), 6592 patients died and 295 started ESRD. Compared with stages 1 and 2 (reference), mortality risk (hazard ratio, 95% confidence interval) was higher in stages 3b-5 (1.66, 1.49-1.86, 2.75, 2.41-3.13 and 2.54, 2.01-3.22, respectively) but not stage 3a (1.11, 0.99-1.23). Similarly, ESRD risk (hazard ratio, 95% confidence interval) was not higher at stage 3a (1.44, 0.79-2.64) but was greater in stages 3b-5 (11.0, 6.3-19.5, 91.2, 53.2-156.2 and, 122.8, 67.9-222.0, respectively). Among modifiable risk factors, anemia and albuminuria significantly predicted either outcome, whereas hypertension only predicted mortality.Conclusions In patients with CKD not referred to nephrology, risks of ESRD and mortality were higher in those with CKD stages 3b-5.

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Unreferred chronic kidney disease: a longitudinal study

Cited by 220 publications

References 41 publications

Macroalbuminuria Is a Better Risk Marker than Low Estimated GFR to Identify Individuals at Risk for Accelerated GFR Loss in Population Screening

Macroalbuminuria Is a Better Risk Marker than Low Estimated GFR to Identify Individuals at Risk for Accelerated GFR Loss in Population Screening

Age Affects Outcomes in Chronic Kidney Disease

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

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