TY - JOUR
T1 - Evaluating the Contribution of the Cause of Kidney Disease to Prognosis in CKD
T2 - Results From the Study of Heart and Renal Protection (SHARP)
AU - Haynes, Richard
AU - Staplin, Natalie
AU - Emberson, Jonathan
AU - Herrington, William G
AU - Tomson, Charles
AU - Agodoa, Lawrence
AU - Tesar, Vladimir
AU - Levin, Adeera
AU - Lewis, David
AU - Reith, Christina
AU - Baigent, Colin
AU - Landray, Martin J
AU - SHARP Collaborative Group
AU - Feldt-Rasmussen, Bo
N1 - Copyright © 2014 National Kidney Foundation, Inc. All rights reserved.
PY - 2014/7
Y1 - 2014/7
N2 - Background The relevance of the cause of kidney disease to prognosis among patients with chronic kidney disease is uncertain. Study Design Observational study. Settings & Participants 6,245 nondialysis participants in the Study of Heart and Renal Protection (SHARP). Predictor Baseline cause of kidney disease was categorized into 4 groups: cystic kidney disease, diabetic nephropathy, glomerulonephritis, and other recorded diagnoses. Outcomes End-stage renal disease (ESRD; dialysis or transplantation) and death. Results During an average 4.7 years' follow-up, 2,080 participants progressed to ESRD, including 454 with cystic kidney disease (23% per year), 378 with glomerulonephritis (10% per year), 309 with diabetic nephropathy (12% per year), and 939 with other recorded diagnoses (8% per year). By comparison with patients with cystic kidney disease, other disease groups had substantially lower adjusted risks of ESRD (relative risks of 0.28 [95% CI, 0.24-0.32], 0.40 [95% CI, 0.34-0.47], and 0.29 [95% CI, 0.25-0.32] for glomerulonephritis, diabetic nephropathy, and other recorded diagnoses, respectively). Albuminuria and baseline estimated glomerular filtration rate were associated more weakly with risk of ESRD in patients with cystic kidney disease than the 3 other diagnostic categories (P for interaction, <0.001 and 0.01, respectively). Death before ESRD was uncommon in patients with cystic kidney disease, but was a major competing risk for participants with diabetic nephropathy, whose adjusted risk of death was 2-fold higher than that of the cystic kidney disease group (relative risk, 2.35 [95% CI, 1.73-3.18]). Limitations Exclusion of patients with prior myocardial infarction or coronary revascularization. Conclusions The cause of kidney disease has substantial prognostic implications. Other things being equal, patients with cystic kidney disease are at much higher risk of ESRD (and much lower risk of death before ESRD) than other patients. Patients with diabetic nephropathy are at particularly high risk of death prior to reaching ESRD.
AB - Background The relevance of the cause of kidney disease to prognosis among patients with chronic kidney disease is uncertain. Study Design Observational study. Settings & Participants 6,245 nondialysis participants in the Study of Heart and Renal Protection (SHARP). Predictor Baseline cause of kidney disease was categorized into 4 groups: cystic kidney disease, diabetic nephropathy, glomerulonephritis, and other recorded diagnoses. Outcomes End-stage renal disease (ESRD; dialysis or transplantation) and death. Results During an average 4.7 years' follow-up, 2,080 participants progressed to ESRD, including 454 with cystic kidney disease (23% per year), 378 with glomerulonephritis (10% per year), 309 with diabetic nephropathy (12% per year), and 939 with other recorded diagnoses (8% per year). By comparison with patients with cystic kidney disease, other disease groups had substantially lower adjusted risks of ESRD (relative risks of 0.28 [95% CI, 0.24-0.32], 0.40 [95% CI, 0.34-0.47], and 0.29 [95% CI, 0.25-0.32] for glomerulonephritis, diabetic nephropathy, and other recorded diagnoses, respectively). Albuminuria and baseline estimated glomerular filtration rate were associated more weakly with risk of ESRD in patients with cystic kidney disease than the 3 other diagnostic categories (P for interaction, <0.001 and 0.01, respectively). Death before ESRD was uncommon in patients with cystic kidney disease, but was a major competing risk for participants with diabetic nephropathy, whose adjusted risk of death was 2-fold higher than that of the cystic kidney disease group (relative risk, 2.35 [95% CI, 1.73-3.18]). Limitations Exclusion of patients with prior myocardial infarction or coronary revascularization. Conclusions The cause of kidney disease has substantial prognostic implications. Other things being equal, patients with cystic kidney disease are at much higher risk of ESRD (and much lower risk of death before ESRD) than other patients. Patients with diabetic nephropathy are at particularly high risk of death prior to reaching ESRD.
KW - Aged
KW - Diabetic Nephropathies
KW - Female
KW - Follow-Up Studies
KW - Glomerular Filtration Rate
KW - Glomerulonephritis
KW - Humans
KW - Kidney Diseases, Cystic
KW - Kidney Failure, Chronic
KW - Kidney Transplantation
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Renal Dialysis
KW - Renal Insufficiency, Chronic
KW - Risk Factors
KW - Survival Rate
U2 - 10.1053/j.ajkd.2013.12.013
DO - 10.1053/j.ajkd.2013.12.013
M3 - Journal article
C2 - 24613056
SN - 0272-6386
VL - 64
SP - 40
EP - 48
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -
