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Comparative Study
. 2011 Apr;26(4):379-85.
doi: 10.1007/s11606-010-1511-x. Epub 2010 Sep 19.

Chronic kidney disease and the risk of end-stage renal disease versus death

Lorien S Dalrymple  1 , Ronit Katz, Bryan Kestenbaum, Michael G Shlipak, Mark J Sarnak, Catherine Stehman-Breen, Stephen Seliger, David Siscovick, Anne B Newman, Linda Fried
Affiliations
Comparative Study

Chronic kidney disease and the risk of end-stage renal disease versus death

Lorien S Dalrymple et al. J Gen Intern Med. 2011 Apr.

Abstract

Background: Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown.

Objective: To compare the rates of ESRD, cardiovascular and non-cardiovascular death and examine risk factors for ESRD and all-cause mortality in Cardiovascular Health Study (CHS) participants.

Design: The CHS is a longitudinal cohort study of community-dwelling adults aged 65 years and older.

Participants: 1,268 participants with an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m(2) were followed until the time of first event (ESRD, cardiovascular or non-cardiovascular death) or until March 31, 2003.

Main measures: The outcomes were ESRD, cardiovascular- and non-cardiovascular death. Rates of each event were calculated, and a Cox Proportional Hazards Model with a competing risk framework was used to examine risk factors for ESRD as compared with death. Predictors included age, gender, race, BMI, hypertension, diabetes, cardiovascular disease, heart failure, tobacco use, eGFR, and total cholesterol.

Key results: During 9.7 years of follow-up, 5% of the cohort progressed to ESRD, and 61% of the cohort died. The rate (per 100 person-years) was 0.5 for ESRD and 6.8 for all-cause mortality (3.0 for cardiovascular and 3.8 for non-cardiovascular mortality). In the competing risk framework, lower eGFR, male gender, African-American race, and higher BMI were associated with an increased risk of ESRD.

Conclusions: Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.

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Figures

Figure 1
Figure 1
Recruitment of Cardiovascular Health Study participants and selection of chronic kidney disease cohort.
Figure 2
Figure 2
The cumulative incidence of end-stage renal disease (ESRD), cardiovascular death, and non-cardiovascular death during follow-up.
See this image and copyright information in PMC

Comment in

References

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