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. 2015 Sep 4;10(9):1575-84.
doi: 10.2215/CJN.00180115. Epub 2015 Aug 18.

Lifetime Risk of Stage 3-5 CKD in a Community-Based Sample in Iceland

Lesley A Inker  1 , Hocine Tighiouart  2 , Thor Aspelund  3 , Vilmundur Gudnason  3 , Tamara Harris  4 , Olafur S Indridason  5 , Runolfur Palsson  6 , Shani Shastri  7 , Andrew S Levey  8 , Mark J Sarnak  8
Affiliations

Lifetime Risk of Stage 3-5 CKD in a Community-Based Sample in Iceland

Lesley A Inker et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Lifetime risk estimates of CKD can be used effectively in public education campaigns. This study sought to estimate lifetime risk of incident CKD stage 3 and higher in Iceland for people without CKD by the age of 45 years.

Design, setting, participants, & measurements: This was a prospective cohort study with longitudinal creatinine measurements of residents in Reykjavik, Iceland, from 1967 to 2005. CKD was ascertained by two consecutive eGFR measurements <60 ml/min per 1.73 m(2), development of treated kidney failure, one eGFR<60 ml/min per 1.73 m(2) if the participant died before the next evaluation, or one eGFR<45 ml/min per 1.73 m(2) if it was the last eGFR.

Results: Mean follow-up was 25 (SD 10) years. Of the study participants, 727 (19%) developed the outcome and 942 (24%) died first. By age 85 years, the lifetime risks for 45-year-old women and men without prevalent CKD were 35.8% (95% confidence interval [95% CI], 32.7 to 38.9) and 21.3% (95% CI, 18.7 to 23.8), respectively. Risk was higher in individuals with a lower eGFR, hypertension, and a higher body mass index. Lifetime risk for higher stages of CKD 3b and 4 were less common than stage 3a; by age 85 years, the lifetime risks for CKD stages 3a, 3b, and 4 in women were 38.5% (95% CI, 25.8 to 51.1), 19.4% (95% CI, 8.9 to 29.9), and 3.6% (95% CI, 2.2 to 5.0), respectively.

Conclusions: The lifetime risk of developing CKD stage 3 or higher is substantial, emphasizing the importance of strategies to prevent development of CKD throughout the course of life. Estimates are lower than reported using single estimates of GFR, emphasizing the importance of confirming estimates of reduced GFR in studies of CKD.

Keywords: CKD; GFR; elderly; epidemiology and outcomes; lifetime risk.

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Figures

Figure 1.
Figure 1.
Change in eGFR over time by baseline age for men and women. Slope of eGFR for each person was calculated from a random-effects mixed model with random intercept and slope. Difference in change in GFR by age was computed per 5 years higher baseline age. 95% CI, 95% confidence interval.
Figure 2.
Figure 2.
Lifetime risk of stages 3–5 CKD for men and women starting at age 45 years. CKD is defined as follows: (1) two consecutive measurements of eGFR<60 ml/min per 1.73 m2, (2) development of treated kidney failure with dialysis or transplant (ESRD), (3) one measurement of eGFR<60 ml/min per 1.73 m2 if the participant died before the next measurement, and (4) one measurement of eGFR<45 ml/min per 1.73 m2 if it was the last eGFR.
Figure 3.
Figure 3.
Lifetime risk of stages 3–5 CKD for men and women starting at age 45 years by subgroup of eGFR (<75, 75–89, or ≥90), hypertension, body mass index (< 25, 25–<30, or ≥30 kg/m2), and smoking (current, past, or never).
Figure 4.
Figure 4.
Lifetime risk for incident CKD stage 3A or higher, stage 3A, stage 3B, and stage 4 or higher. CKD stage was defined using one measurement of GFR below the threshold. ESRD was included in CKD stage 3a or higher or stage 4.
See this image and copyright information in PMC

Comment in

  • Lifetime Risk of CKD: What Does It Really Mean?
    Delanaye P, Glassock RJ. Delanaye P, et al. Clin J Am Soc Nephrol. 2015 Sep 4;10(9):1504-6. doi: 10.2215/CJN.07860715. Epub 2015 Aug 18. Clin J Am Soc Nephrol. 2015. PMID: 26286926 Free PMC article. No abstract available.

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