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Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study.
Am J Kidney Dis 2014; 63(2):236-43AJ

Abstract

BACKGROUND

Various indicators of progression of chronic kidney disease (CKD) have been used as outcomes in clinical research studies. The effect of using varying measures on the association of risk factors with CKD progression has not been well characterized.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

The Chronic Renal Insufficiency Cohort (CRIC) Study (N=3,939) enrolled men and women with mild to moderate CKD, 48% of whom had diabetes and 42% were self-reported black race.

PREDICTORS

Age, race, sex, diabetes, baseline estimated glomerular filtration rate (eGFR), proteinuria, and other established CKD risk factors.

OUTCOMES

Death, end-stage renal disease (ESRD), and eGFR events, including: (1) eGFR halving, (2) eGFR<15mL/min/1.73m(2), (3) eGFR halving and <15mL/min/1.73m(2), (4) eGFR decrease of 20mL/min/1.73m(2), (5) eGFR halving or decrease of 20mL/min/1.73m(2), and (6) eGFR decrease of 25% and change in CKD stage.

RESULTS

Mean entry eGFR was 44.9mL/min/1.73m(2). Annual rates of death, ESRD, and eGFR halving were 2.5%, 4.0%, and 6.1%, respectively, during an average follow-up of 5.4 years. Associations between risk factors and ESRD and eGFR events were similar across different definitions. However, these associations were substantially different from those with death. HRs for ESRD, eGFR halving, and death in the highest compared to the lowest proteinuria category were 11.83 (95% CI, 8.40-16.65), 11.19 (95% CI, 8.53-14.68), and 1.47 (95% CI, 1.10-1.96), respectively.

LIMITATIONS

Participants may not be representative of the entire CKD population.

CONCLUSIONS

Using ESRD or eGFR events, but not death, in the definition of kidney disease outcomes is appropriate in follow-up studies to identify risk factors for CKD progression.

Authors+Show Affiliations

University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: weiyang@mail.med.upenn.edu.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.University of Utah, Salt Lake City, UT.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.University of California at San Francisco, San Francisco, CA.University of Maryland, Baltimore, MD.Tulane University, New Orleans, LA.University of Illinois at Chicago, Chicago, IL.University of Michigan, Ann Arbor, MI.Case Western Reserve University, Cleveland, OH.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24182662

Citation

Yang, Wei, et al. "Association of Kidney Disease Outcomes With Risk Factors for CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 63, no. 2, 2014, pp. 236-43.
Yang W, Xie D, Anderson AH, et al. Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney Dis. 2014;63(2):236-43.
Yang, W., Xie, D., Anderson, A. H., Joffe, M. M., Greene, T., Teal, V., ... Feldman, H. I. (2014). Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 63(2), pp. 236-43. doi:10.1053/j.ajkd.2013.08.028.
Yang W, et al. Association of Kidney Disease Outcomes With Risk Factors for CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2014;63(2):236-43. PubMed PMID: 24182662.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. AU - Yang,Wei, AU - Xie,Dawei, AU - Anderson,Amanda H, AU - Joffe,Marshall M, AU - Greene,Tom, AU - Teal,Valerie, AU - Hsu,Chi-yuan, AU - Fink,Jeffrey C, AU - He,Jiang, AU - Lash,James P, AU - Ojo,Akinlolu, AU - Rahman,Mahboob, AU - Nessel,Lisa, AU - Kusek,John W, AU - Feldman,Harold I, AU - ,, Y1 - 2013/10/30/ PY - 2013/01/17/received PY - 2013/08/30/accepted PY - 2013/11/5/entrez PY - 2013/11/5/pubmed PY - 2014/3/19/medline KW - Chronic Renal Insufficiency Cohort (CRIC) KW - Kidney disease progression KW - chronic kidney disease (CKD) KW - decreased estimated glomerular filtration rate (eGFR) KW - disease trajectory KW - end-stage renal disease (ESRD) KW - estimated glomerular filtration rate (eGFR) KW - longitudinal outcome KW - mortality risk KW - renal function SP - 236 EP - 43 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 63 IS - 2 N2 - BACKGROUND: Various indicators of progression of chronic kidney disease (CKD) have been used as outcomes in clinical research studies. The effect of using varying measures on the association of risk factors with CKD progression has not been well characterized. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: The Chronic Renal Insufficiency Cohort (CRIC) Study (N=3,939) enrolled men and women with mild to moderate CKD, 48% of whom had diabetes and 42% were self-reported black race. PREDICTORS: Age, race, sex, diabetes, baseline estimated glomerular filtration rate (eGFR), proteinuria, and other established CKD risk factors. OUTCOMES: Death, end-stage renal disease (ESRD), and eGFR events, including: (1) eGFR halving, (2) eGFR<15mL/min/1.73m(2), (3) eGFR halving and <15mL/min/1.73m(2), (4) eGFR decrease of 20mL/min/1.73m(2), (5) eGFR halving or decrease of 20mL/min/1.73m(2), and (6) eGFR decrease of 25% and change in CKD stage. RESULTS: Mean entry eGFR was 44.9mL/min/1.73m(2). Annual rates of death, ESRD, and eGFR halving were 2.5%, 4.0%, and 6.1%, respectively, during an average follow-up of 5.4 years. Associations between risk factors and ESRD and eGFR events were similar across different definitions. However, these associations were substantially different from those with death. HRs for ESRD, eGFR halving, and death in the highest compared to the lowest proteinuria category were 11.83 (95% CI, 8.40-16.65), 11.19 (95% CI, 8.53-14.68), and 1.47 (95% CI, 1.10-1.96), respectively. LIMITATIONS: Participants may not be representative of the entire CKD population. CONCLUSIONS: Using ESRD or eGFR events, but not death, in the definition of kidney disease outcomes is appropriate in follow-up studies to identify risk factors for CKD progression. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/24182662/Association_of_kidney_disease_outcomes_with_risk_factors_for_CKD:_findings_from_the_Chronic_Renal_Insufficiency_Cohort__CRIC__study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(13)01223-7 DB - PRIME DP - Unbound Medicine ER -