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The natural history of chronic renal failure: results from an unselected, population-based, inception cohort in Sweden.
Am J Kidney Dis. 2005 Nov; 46(5):863-70.AJ

Abstract

BACKGROUND

Mortality rates in patients with chronic renal failure (CRF) are high both before and after start of renal replacement therapy (RRT). However, few studies of mortality and progression have been performed in an unselected CRF population.

METHODS

We followed up a population-based inception cohort of 920 men and women aged 18 to 74 years who had CRF (serum creatinine level > 3.4 mg/dL [>300 micromol/L] for men and >2.8 mg/dL [>250 micromol/L] for women) for 55 to 79 months. Relationships between the outcomes (death and start of RRT) and independent variables under study (age, sex, primary renal disease, body mass index [BMI], and glomerular filtration rate [GFR] at entry) were explored by using Cox regression models.

RESULTS

Seven hundred thirty-nine patients (80%) started RRT during the follow-up period. As expected, GFR at entry was clearly linked to the incidence of RRT (P < 0.0001). Age was related inversely to incidence of RRT (adjusted relative risk for patients > or =65 years relative to patients <45 years, 0.72; 95% confidence interval, 0.57 to 0.90). Men progressed to RRT more often than women (adjusted relative risk, 1.59; 95% confidence interval, 1.35 to 1.88). BMI was unrelated to RRT incidence. By the end of follow-up, 389 patients with CRF (42%) had died, 89 of them (10%) before the start of RRT. The most common primary cause of death was cardiovascular disease (37.5%). Characteristics significantly related to a greater mortality rate included older age, diagnoses of diabetic nephropathy and nephrosclerosis, and low BMI.

CONCLUSION

Preuremic characteristics (age, sex, primary renal diagnosis, BMI, and GFR) are predictive of prognosis in unselected patients with CRF.

Authors+Show Affiliations

Department of Clinical Sciences, Karolinska University Hospital, Huddinge, Sweden. marie.evans@klinvet.ki.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16253726

Citation

Evans, Marie, et al. "The Natural History of Chronic Renal Failure: Results From an Unselected, Population-based, Inception Cohort in Sweden." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 46, no. 5, 2005, pp. 863-70.
Evans M, Fryzek JP, Elinder CG, et al. The natural history of chronic renal failure: results from an unselected, population-based, inception cohort in Sweden. Am J Kidney Dis. 2005;46(5):863-70.
Evans, M., Fryzek, J. P., Elinder, C. G., Cohen, S. S., McLaughlin, J. K., Nyrén, O., & Fored, C. M. (2005). The natural history of chronic renal failure: results from an unselected, population-based, inception cohort in Sweden. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 46(5), 863-70.
Evans M, et al. The Natural History of Chronic Renal Failure: Results From an Unselected, Population-based, Inception Cohort in Sweden. Am J Kidney Dis. 2005;46(5):863-70. PubMed PMID: 16253726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The natural history of chronic renal failure: results from an unselected, population-based, inception cohort in Sweden. AU - Evans,Marie, AU - Fryzek,Jon P, AU - Elinder,Carl-Gustaf, AU - Cohen,Sarah S, AU - McLaughlin,Joseph K, AU - Nyrén,Olof, AU - Fored,C Michael, PY - 2005/03/10/received PY - 2005/07/12/accepted PY - 2005/10/29/pubmed PY - 2005/12/13/medline PY - 2005/10/29/entrez SP - 863 EP - 70 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 46 IS - 5 N2 - BACKGROUND: Mortality rates in patients with chronic renal failure (CRF) are high both before and after start of renal replacement therapy (RRT). However, few studies of mortality and progression have been performed in an unselected CRF population. METHODS: We followed up a population-based inception cohort of 920 men and women aged 18 to 74 years who had CRF (serum creatinine level > 3.4 mg/dL [>300 micromol/L] for men and >2.8 mg/dL [>250 micromol/L] for women) for 55 to 79 months. Relationships between the outcomes (death and start of RRT) and independent variables under study (age, sex, primary renal disease, body mass index [BMI], and glomerular filtration rate [GFR] at entry) were explored by using Cox regression models. RESULTS: Seven hundred thirty-nine patients (80%) started RRT during the follow-up period. As expected, GFR at entry was clearly linked to the incidence of RRT (P < 0.0001). Age was related inversely to incidence of RRT (adjusted relative risk for patients > or =65 years relative to patients <45 years, 0.72; 95% confidence interval, 0.57 to 0.90). Men progressed to RRT more often than women (adjusted relative risk, 1.59; 95% confidence interval, 1.35 to 1.88). BMI was unrelated to RRT incidence. By the end of follow-up, 389 patients with CRF (42%) had died, 89 of them (10%) before the start of RRT. The most common primary cause of death was cardiovascular disease (37.5%). Characteristics significantly related to a greater mortality rate included older age, diagnoses of diabetic nephropathy and nephrosclerosis, and low BMI. CONCLUSION: Preuremic characteristics (age, sex, primary renal diagnosis, BMI, and GFR) are predictive of prognosis in unselected patients with CRF. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16253726/The_natural_history_of_chronic_renal_failure:_results_from_an_unselected_population_based_inception_cohort_in_Sweden_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)01051-6 DB - PRIME DP - Unbound Medicine ER -