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Secular trends in kidney disease: is the decreased incidence of renal replacement therapy due to a decrease in
M L Thorp1, J R Weinstein, E S Johnson
1Department of Nephrology, Kaiser Permanente Northwest, Lake Road Nephrology Center, Milwaukie, OR, USA.
Insights
The number of chronic kidney disease (CKD) patients increased, but renal replacement therapy (RRT) incidence remained stable from 1998 to 2005. This suggests improved CKD identification may be a factor.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Chronic kidney disease (CKD) affects a significant population, with limited understanding of its epidemiological trends.
- Renal replacement therapy (RRT) is a critical intervention for end-stage renal disease, but its incidence patterns in CKD populations are not well-documented.
Purpose of the Study:
- To investigate trends in CKD incidence and RRT incidence within a health maintenance organization (HMO) population.
- To analyze changes in RRT rates among individuals diagnosed with CKD over a defined period.
Main Methods:
- Yearly incidence rates of RRT were calculated from 1998 to 2005.
- CKD was defined using National Kidney Foundation criteria (2 estimated glomerular filtration rates <60 ml/min/1.73 m² 90+ days apart).
- Poisson regression was used to assess year-to-year incidence rate differences.
Main Results:
- The number of diagnosed CKD patients increased from 3,861 in 1998 to 5,242 in 2005.
- While hypertension prevalence rose significantly among CKD patients, diabetes prevalence remained stable.
- Mean estimated glomerular filtration rate in CKD patients showed a minimal increase, and age/sex-adjusted RRT rates varied without a consistent temporal pattern.
Conclusions:
- Despite a growing number of CKD diagnoses, the incidence of RRT among CKD patients showed little change between 1998 and 2005.
- The observed discrepancy may be attributed to enhanced laboratory identification and diagnosis of CKD.
- Further research is needed to understand the long-term implications of these trends on kidney disease management.
Aims:
Little is known about trends in renal replacement therapy among patients with chronic kidney disease (CKD) or about changes in the incidence of CKD. We studied the incidence of renal replacement therapy within the population of a health maintenance organization (HMO) both among the entire HMO population and among those with CKD.
Methods:
We calculated yearly incidence rates of renal replacement therapy for each year from 1998 to 2005. We defined CKD using the National Kidney Foundation definition of 2 estimated glomerular filtration rates below 60 ml/min/1.73 m2 90 or more days apart. Poisson regression assessed year-to-year differences.
Results:
The number of patients with CKD rose consistently from 3,861 in 1998 to 5,242 in 2005. The proportion of patients who had been diagnosed with hypertension rose from 86.7% (starting renal replacement therapy) or 34.5% (with CKD) to 99.1 and 46.9%. The proportion of patients with diabetes changed little throughout the years studied. The mean estimated glomerular filtration rate among CKD patients rose minimally from 38.4 ml/min/1.73 m2 in 1998 to 39.9 ml/min/1.73 m2 in 2005. Age- and sex-adjusted rates of RRT among patients with CKD varied (p=0.0034), but did not follow a consistent pattern over time.
Conclusions:
Incidence of renal replacement therapy among patients with CKD changed little between 1998 and 2005, despite an increase in the number of patients diagnosed with CKD. The discrepancy may be due to increased laboratory identification of CKD.
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