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. 2020 May 1;35(5):803-810.
doi: 10.1093/ndt/gfz260.

Chronic kidney disease progression and mortality risk profiles in Germany: results from the Chronic Kidney Disease Outcomes and Practice Patterns Study

Helmut Reichel  1 , Jarcy Zee  2 , Charlotte Tu  2 , Eric Young  2 , Ronald L Pisoni  2 , Bénédicte Stengel  3 , Johannes Duttlinger  4 , Gerhard Lonnemann  5 , Bruce M Robinson  2 , Roberto Pecoits-Filho  2 , Danilo Fliser  6
Affiliations

Chronic kidney disease progression and mortality risk profiles in Germany: results from the Chronic Kidney Disease Outcomes and Practice Patterns Study

Helmut Reichel et al. Nephrol Dial Transplant. .

Abstract

Background: Chronic kidney disease (CKD) progression among German patients in a representative setting has not been described previously. The Verband Deutsche Nierenzentren and Chronic Kidney Disease Outcomes and Practice Patterns Study established a longitudinal observational cohort among German CKD patients to research variations in patient care and outcomes in real-world nephrology practices.

Methods: A cohort of CKD Stages 3 (25%) and 4 (75%) patients was established from German nephrologist-run CKD clinics in 2013-16. Linear models were used to determine the estimated glomerular filtration rate (eGFR) slope during follow-up and Cox models were used to assess outcomes of end-stage kidney disease (ESKD) and death.

Results: A total of 1834 patients (median age 75 years, 58% male, 42% diabetics, median baseline eGFR 25 mL/min/1.73 m2) were followed for a median of 29 months. More than 50% had slow or no decline and 17% declined ≥5 mL/min/1.73 m2/year. After 4.5 years, the incidence of ESKD was 8% and of deaths without ESKD 16% among patients with eGFR ≥30 mL/min/1.73 m2 and 37% and 19% for eGFR <30 mL/min/1.73 m2. Adjusted models showed higher risks of ESKD or death for patients with worse kidney function at baseline, male sex, diabetes and higher blood pressure; a higher risk of ESKD with higher albuminuria; and a higher risk of death with older age or cardiovascular comorbidity.

Conclusions: Routine nephrology care of patients in Germany comprises mostly elderly patients, many with slow CKD progression. Identification of risk factors for CKD progression and mortality may help guide resources by closer follow-up of high-risk patients.

Keywords: CKD progression; chronic kidney disease; mortality.

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Figures

FIGURE 1
FIGURE 1
Yearly change in eGFR over the follow-up by eGFR at study entry. Analyses are restricted to patients with at least 6 months of eGFR data. Shading denotes the proportion in each category who progressed to ESKD or death during the study follow-up.
FIGURE 2
FIGURE 2
Cumulative incidence of ESKD, death without ESKD and ESKD-free survival by eGFR at study entry.
See this image and copyright information in PMC

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