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

Pietro Manuel Ferraro, Katharina Brück, Kitty J. Jager, Carmine Zoccali, Aminu K. Bello, Roberto Minutolo, Kyriakos Ioannou, Francis Verbeke, Henry Völzke, Johan Arnlöv, Daniela Leonardis, Hermann Brenner, Ben Caplin, Philip A. Kalra, Christoph Wanner, Alberto Martinez Castelao, Jose Luis Gorriz, Stein Hallan, Dietrich Rothenbacher, Dino GibertoniLuca De Nicola, Georg Heinze, Wim Van Biesen, Vianda S. Stel

Risultato della ricerca: Contributo in rivistaArticolo in rivista

16 Citazioni (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/1.73m2in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m2in 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.
Lingua originaleEnglish
pagine (da-a)1432-1441
RivistaKidney International
Volume93
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

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

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