Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe

European CKD Burden Consortium

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

The incidence of renal replacement therapy varies across countries. However, little is known about the epidemiology of chronic kidney disease (CKD) outcomes. Here we describe progression and mortality risk of patients with CKD but not on renal replacement therapy at outpatient nephrology clinics across Europe using individual data from nine CKD cohorts participating in the European CKD Burden Consortium. A joint model assessed the mean change in estimated glomerular filtration rate (eGFR) and mortality risk simultaneously, thereby accounting for mortality risk when estimating eGFR decline and vice versa, while also correcting for the measurement error in eGFR. Results were adjusted for important risk factors (baseline eGFR, age, sex, albuminuria, primary renal disease, diabetes, hypertension, obesity and smoking) in 27,771 patients from five countries. The adjusted mean annual eGFR decline varied from 0.77 (95% confidence interval 0.45, 1.08) ml/min/1.73m2 in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m2 in the Spanish cohort. As compared to the Italian PIRP cohort, the adjusted mortality hazard ratio varied from 0.22 (0.11, 0.43) in the London LACKABO cohort to 1.30 (1.13, 1.49) in the English CRISIS cohort. These results suggest that the eGFR decline showed minor variation but mortality showed the most variation. Thus, different health care organization systems are potentially associated with differences in outcome of patients with CKD within Europe. These results can be used by policy makers to plan resources on a regional, national and European level.

Original languageEnglish
Pages (from-to)1432-1441
Number of pages10
JournalKidney International
Volume93
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

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Nephrology
Ambulatory Care Facilities
Glomerular Filtration Rate
Chronic Renal Insufficiency
Mortality
Renal Replacement Therapy
Albuminuria
Belgium
Administrative Personnel
Epidemiology
Obesity
Joints
Smoking
Organizations
Confidence Intervals
Hypertension
Delivery of Health Care
Kidney
Incidence

Keywords

  • ACE inhibitors
  • cardiovascular disease
  • chronic kidney disease
  • diabetes
  • obesity

ASJC Scopus subject areas

  • Nephrology

Cite this

Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe. / European CKD Burden Consortium.

In: Kidney International, Vol. 93, No. 6, 01.06.2018, p. 1432-1441.

Research output: Contribution to journalArticle

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abstract = "The incidence of renal replacement therapy varies across countries. However, little is known about the epidemiology of chronic kidney disease (CKD) outcomes. Here we describe progression and mortality risk of patients with CKD but not on renal replacement therapy at outpatient nephrology clinics across Europe using individual data from nine CKD cohorts participating in the European CKD Burden Consortium. A joint model assessed the mean change in estimated glomerular filtration rate (eGFR) and mortality risk simultaneously, thereby accounting for mortality risk when estimating eGFR decline and vice versa, while also correcting for the measurement error in eGFR. Results were adjusted for important risk factors (baseline eGFR, age, sex, albuminuria, primary renal disease, diabetes, hypertension, obesity and smoking) in 27,771 patients from five countries. The adjusted mean annual eGFR decline varied from 0.77 (95{\%} confidence interval 0.45, 1.08) ml/min/1.73m2 in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m2 in the Spanish cohort. As compared to the Italian PIRP cohort, the adjusted mortality hazard ratio varied from 0.22 (0.11, 0.43) in the London LACKABO cohort to 1.30 (1.13, 1.49) in the English CRISIS cohort. These results suggest that the eGFR decline showed minor variation but mortality showed the most variation. Thus, different health care organization systems are potentially associated with differences in outcome of patients with CKD within Europe. These results can be used by policy makers to plan resources on a regional, national and European level.",
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