Lifetime risk of ESRD

Abstract

Lifetime risk is the cumulative risk of experiencing an outcome between a disease-free index age and death. The lifetime risk of ESRD for a middle-aged individual is a relevant and easy to communicate measure of disease burden. We estimated lifetime risk of ESRD in a cohort of 2,895,521 adults without ESRD from 1997 to 2008. To estimate lifetime risk of ESRD by level of baseline kidney function, we analyzed a cohort of participants who had a serum creatinine measurement. We also estimated the sex- and index age-specific lifetime risk of incident ESRD and accounted for the competing risk of death. Among those individuals without ESRD at age 40 years, the lifetime risk of ESRD was 2.66% for men and 1.76% for women. The risk was higher in persons with reduced kidney function: for eGFR=44-59 ml/min per 1.73 m(2), the lifetime risk of ESRD was 7.51% for men and 3.21% for women, whereas men and women with relatively preserved kidney function (eGFR=60-89 ml/min per 1.73 m(2)) had lifetime risks of ESRD of 1.01% and 0.63%, respectively. The lifetime risk of ESRD was consistently higher for men at all ages and eGFR strata compared with women. In conclusion, approximately 1 in 40 men and 1 in 60 women of middle age will develop ESRD during their lifetimes (living into their 90s). These population-based estimates may assist individuals who make decisions regarding public health policy.

Figure 1.

Overview of cohort creation. (A) The primary study cohort consisted of Alberta residents aged 18 years or older registered with Alberta Health and Wellness from April 1, 1997 to March 31, 2008. (B) Cohort of participants who had at least one outpatient serum creatinine measurement from May 1, 2002 to March 31, 2008.

Figure 2.

Cumulative risk of ESRD (in percentage) with advancing age for men and women at the index age of 40 years.

Figure 3.

Competing risk of death-adjusted cumulative risk of ESRD (in percentage) with advancing age by eGFR category for men and women at the index ages of 40 and 70 years. eGFR was categorized as ≥90, 60–89, 45–59, and 30–44 ml/min per 1.73 m².