Related Experiment Video
Updated: Aug 5, 2025
Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
CKD Progression Risk and Subsequent Cause of Death: A Population-Based Cohort Study
Nayanjot K Rai1, Zheng Wang2, Paul E Drawz1
1Division of Nephrology and Hypertension, University of Minnesota Medical School, Minneapolis, Minnesota.
Insights
Cardiovascular disease (CVD) is the leading cause of death in chronic kidney disease (CKD) patients with reduced estimated glomerular filtration rate (eGFR), regardless of disease progression. This finding highlights the critical link between kidney function and cardiovascular mortality.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Chronic kidney disease (CKD) is a major health concern with high mortality rates.
- Cardiovascular disease (CVD) is the primary cause of death in CKD patients, but data on specific causes of death in relation to CKD progression are limited.
- Understanding the causes of death in CKD is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the causes of death in patients with chronic kidney disease (CKD).
- To compare the causes of death between patients with progressive CKD and those with stable kidney function.
- To evaluate the impact of reduced estimated glomerular filtration rate (eGFR) and proteinuria on mortality in CKD.
Main Methods:
- Retrospective cohort study utilizing data from M Health Fairview (MHFV) and the National Health and Nutrition Examination Survey (NHANES).
- Inclusion of adult primary care patients and NHANES participants with linked death index data, excluding those on kidney replacement therapy.
- Exposure categories defined by eGFR and proteinuria; CKD progression defined by eGFR decrease or incident kidney replacement therapy.
Main Results:
- Cardiovascular disease (CVD) death was more common than malignancy death in individuals with eGFR <60 mL/min/1.73 m².
- In the NHANES cohort, CVD deaths were higher in individuals with proteinuria and eGFR ≥60 mL/min/1.73 m².
- CKD progression had a limited impact on the cause of death, except for dementia deaths, which were less common with progression.
Conclusions:
- Cardiovascular disease (CVD) is the most significant cause of death in individuals with reduced eGFR, irrespective of CKD progression.
- The findings underscore the critical importance of managing cardiovascular risk factors in CKD patients.
- Further research with longer follow-up and standardized measures is needed to confirm these findings.
Rationale & Objective:
Chronic kidney disease (CKD) is a prevalent condition with high mortality rates. Cardiovascular disease (CVD) is accepted as the leading cause of death in CKD, but data are limited, and no study has evaluated the cause of death in those with progressive CKD versus stable kidney function.
Study Design:
Retrospective cohort.
Setting & Participants:
Adults receiving primary care at M Health Fairview (MHFV) after December 31, 2012, with linked Minnesota Death Index data before December 31, 2019, were included. A second cohort was created from adult participants in the 1996-2006 National Health and Nutrition Examination Survey (NHANES) linked with the National Death Index through 2015. Individuals with kidney replacement therapy at baseline were excluded.
Exposures:
Estimated glomerular filtration rate (eGFR) and proteinuria assessed at baseline defined the exposure categories for MHFV and NHANES. CKD progression in MHFV was also defined as an eGFR decrease ≥30% from baseline or incident kidney replacement therapy.
Outcome:
CVD-, malignancy-, and dementia-attributed death.
Analytical Approach:
Multinomial logistic regression.
Results:
For both cohorts, CVD death was more common than malignancy death for those with eGFR <60 mL/min/1.73 m2, whereas the converse was true for those with higher eGFR without proteinuria. In NHANES, CVD deaths were higher in those with proteinuria and eGFR ≥60 mL/min/1.73 m2. CKD progression in MHFV had a limited impact on the association with the cause of death except on dementia deaths, which were less common with progression at several stages of CKD. Proteinuria had limited impact on the association with the cause of death across a range of eGFR levels.
Limitations:
Limited follow-up and, for MHFV, nonprotocolized measures of kidney function were limitations, as were the intrinsic accuracy limitations for death certificates.
Conclusions:
CVD death is the most significant cause of death observed for those with a reduced eGFR irrespective of CKD progression.
Related Concept Videos
01:25Chronic Kidney Disease I: Introduction
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:15Assumptions of Survival Analysis
01:30Coronary Artery Disease I: Introduction
01:21Cancer Survival Analysis
01:24Kaplan-Meier Approach