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. 2024 Jun 28;39(7):1150-1158.
doi: 10.1093/ndt/gfad271.

Risk factor analysis for a rapid progression of chronic kidney disease

Anne H S Vestergaard  1 , Simon K Jensen  1 , Uffe Heide-Jørgensen  1 , Line E Frederiksen  2 , Henrik Birn  3   4 , Dorte E Jarbøl  5 , Jens Søndergaard  5 , Frederik Persson  6 , Reimar W Thomsen  1 , Christian F Christiansen  1
Affiliations

Risk factor analysis for a rapid progression of chronic kidney disease

Anne H S Vestergaard et al. Nephrol Dial Transplant. .

Abstract

Background: Chronic kidney disease (CKD) is a growing global health concern. Identifying individuals in routine clinical care with new-onset CKD at high risk of rapid progression of the disease is imperative to guide allocation of prophylactic interventions, but community-based data are limited. We aimed to examine the risk of rapid progression, kidney failure, hospitalization and death among adults with incident CKD stage G3 and to clarify the association between predefined risk markers and rapid CKD progression.

Methods: Using plasma creatinine measurements for the entire Danish population from both hospitals and primary care, we conducted a nationwide, population-based cohort study, including adults in Denmark with incident CKD stage G3 in 2017-2020. We estimated 3-year risks of rapid progression (defined by a confirmed decline in estimated glomerular filtration rate of ≥5 mL/min/1.73 m2/year), kidney failure, all-cause hospitalization and death. To examine risk markers, we constructed a heat map showing the risk of rapid progression based on predefined markers: albuminuria, sex, diabetes and hypertension/cardiovascular disease.

Results: Among 133 443 individuals with incident CKD stage G3, the 3-year risk of rapid progression was 14.6% [95% confidence interval (CI) 14.4-14.8]. The 3-year risks of kidney failure, hospitalization and death were 0.3% (95% CI 0.3-0.4), 53.3% (95% CI 53.0-53.6) and 18.1% (95% CI 17.9-18.4), respectively. In the heat map, the 3-year risk of rapid progression ranged from 7% in females without albuminuria, hypertension/cardiovascular disease or diabetes, to 46%-47% in males and females with severe albuminuria, diabetes and hypertension/cardiovascular disease.

Conclusion: This population-based study shows that CKD stage G3 is associated with considerable morbidity in a community-based setting and underscores the need for optimized prophylactic interventions among such patients. Moreover, our data highlight the potential of using easily accessible markers in routine clinical care to identify individuals who are at high risk of rapid progression.

Keywords: disease progression; hospitalization; mortality; renal insufficiency; risk.

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Conflict of interest statement

The present study was funded by a grant from AstraZeneca to Aarhus University. L.E.F. is an employee of AstraZeneca. H.B., D.E.J., J.S. and F.P. received consultancy fees for the present study from AstraZeneca. A.H.S.V., S.K.J., U.H.-J., R.W.T. and C.F.C. do not report any personal conflicts of interest relevant to this study. The Department of Clinical Epidemiology, Departments of Clinical Medicine and Biomedicine and Department of Renal Medicine are involved in other studies with funding from various companies as research grants to (and administered by) Aarhus University.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Risk of rapid progression, kidney failure, hospitalization and mortality against time.
Figure 2:
Figure 2:
Estimated 3-year risks of rapid progression by relevant risk markers.
See this image and copyright information in PMC

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