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Risk factor analysis for a rapid progression of chronic kidney disease
Anne H S Vestergaard1, Simon K Jensen1, Uffe Heide-Jørgensen1
1Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Insights
Identifying new chronic kidney disease (CKD) stage G3 patients at high risk of rapid progression is crucial. Easily accessible markers like albuminuria, sex, diabetes, and cardiovascular disease can predict rapid CKD progression in routine care.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Chronic kidney disease (CKD) poses a growing global health challenge.
- Limited community-based data exist for identifying new-onset CKD patients at high risk of rapid progression.
- Early identification is vital for implementing prophylactic interventions.
Purpose of the Study:
- To examine the risk of rapid progression, kidney failure, hospitalization, and death in adults with incident CKD stage G3.
- To clarify the association between predefined risk markers and rapid CKD progression.
Main Methods:
- Nationwide, population-based cohort study using plasma creatinine from Danish hospitals and primary care (2017-2020).
- Inclusion of adults with incident CKD stage G3.
- Estimation of 3-year risks for rapid progression (≥5 mL/min/1.73 m²/year decline in eGFR), kidney failure, hospitalization, and death.
- Construction of a heat map to visualize risk based on albuminuria, sex, diabetes, and hypertension/cardiovascular disease.
Main Results:
- Among 133,443 individuals with incident CKD stage G3, the 3-year risk of rapid progression was 14.6%.
- The 3-year risks were 0.3% for kidney failure, 53.3% for hospitalization, and 18.1% for death.
- Risk of rapid progression varied from 7% in low-risk females to 46%-47% in high-risk males and females with albuminuria, diabetes, and hypertension/cardiovascular disease.
Conclusions:
- CKD stage G3 is linked to significant morbidity in community settings, necessitating optimized prophylactic interventions.
- Accessible markers like albuminuria, sex, diabetes, and cardiovascular disease can effectively identify high-risk individuals for rapid progression.
- These findings support the use of routine clinical data for risk stratification in CKD management.
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.
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