Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up

Angharad Marks; Nicholas Fluck; Gordon J. Prescott; Lynn Marie Robertson; William G. Simpson; William Cairns S. Smith; Corri Black

doi:10.1093/ndt/gft393

Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up

Angharad Marks^*
, Nicholas Fluck
, Gordon J. Prescott
, Lynn Marie Robertson
, William G. Simpson
, William Cairns S. Smith
, Corri Black

^*Corresponding author for this work

GRAMPIAN UNIVERSITY HOSPITALS NHS TRUST
University of Aberdeen

Research output: Contribution to journal › Article › peer-review

25 Citations (Scopus)

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Abstract

Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.

Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.

Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44% were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95% CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95% CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.

Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.

Original language	English
Pages (from-to)	333-341
Number of pages	9
Journal	Nephrology Dialysis Transplantation
Volume	29
Issue number	2
Early online date	29 Sept 2013
DOIs	https://doi.org/10.1093/ndt/gft393
Publication status	Published - Feb 2014

Funding

Ongoing work on predicting the risk in CKD in this cohort and a larger population cohort was supported by a grant from the Chief Scientist Office, Scotland (CZH/4/656). A grant to investigate acute renal failure from Kidney Research UK in 2004 allowed the set up of the cohort.

Keywords

chronic kidney disease
cohort
progression
renal replacement therapy
risk-factors
CKD
epidemiology
outcomes
decline
cost
care
GFR
Glomerular Filtration Rate
renal insufficiency, chronic

Access to Document

10.1093/ndt/gft393

NDT Progression paper 15072013 V11 noredblue
This is a pre-copyedited, author-produced PDF of an article accepted for publication in Nephrology Dialysis Transplantation following peer review. The version of record Marks, A, Fluck, N, Prescott, GJ, Robertson, LM, Simpson, WG, Smith, WCS & Black, C 2014, 'Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up' Nephrology Dialysis Transplantation, vol 29, no. 2, pp. 333-341.is available online at: http://ndt.oxfordjournals.org/content/29/2/333
Accepted author manuscript, 425 KB

Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS)
Black, C. (Creator), Marks, A. (Creator) & St Clair Gibson, A. (Other), Grampian Data Safe Haven, 2014
http://www.abdn.ac.uk/ims/research/immunology/renal-304.php
Dataset

Cite this

@article{341d247adab445f4847d83e31ab3c550,

title = "Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up",

abstract = "Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44\% were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95\% CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95\% CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.",

keywords = "chronic kidney disease, cohort, progression, renal replacement therapy, risk-factors, CKD, epidemiology, outcomes, decline, cost, care , GFR, Glomerular Filtration Rate, renal insufficiency, chronic",

author = "Angharad Marks and Nicholas Fluck and Prescott, \{Gordon J.\} and Robertson, \{Lynn Marie\} and Simpson, \{William G.\} and Smith, \{William Cairns S.\} and Corri Black",

year = "2014",

month = feb,

doi = "10.1093/ndt/gft393",

language = "English",

volume = "29",

pages = "333--341",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

number = "2",

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TY - JOUR

T1 - Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up

AU - Marks, Angharad

AU - Fluck, Nicholas

AU - Prescott, Gordon J.

AU - Robertson, Lynn Marie

AU - Simpson, William G.

AU - Smith, William Cairns S.

AU - Black, Corri

PY - 2014/2

Y1 - 2014/2

N2 - Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44% were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95% CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95% CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.

AB - Background. Chronic kidney disease (CKD) is common, important and associated with increased healthcare needs due to CKD progression. Definitions of renal disease progression are multiple, and not always comparable. A measure of 'progression' directly comparable with renal replacement therapy (RRT) initiation would identify 'progressors' in research and for healthcare planning.Methods. The Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS-I) is a community cohort with CKD from 2003, followed up to June 2009 for (i) RRT initiation and (ii) 'progression': sustained reduction in estimated glomerular filtration rate (eGFR) by 15 mL/min/1.73 m(2) (equivalent to CKD stage change), or to <10 mL/min/1.73 m(2), whichever occurs first. Predictors were baseline demographics and comorbidity. The use of the Kidney Disease: Improving Global Outcomes-2012 progression definition was also explored.Results. Two thousand two hundred and eighty-nine and 1044 had Stage 3 and 4 CKD, 44% were males. Overall, RRT initiation and progression rates were 0.97 and 3.50 per 100 patient-years (py). Females had significantly lower progression and RRT initiation rates. The progression rate was not dependent on CKD stage [incidence rate ratio (IRR) for Stage 4 (versus Stage 3) 0.9 (95% CI 0.8-1.2)], whereas the RRT initiation rate was [IRR 5.6 (95% CI 3.8-8.2)]. Increased proteinuria was associated with both greater RRT initiation and progression rates.Conclusions. Progression and RRT initiation rate ratios allow comparison of predictors of these outcomes. Higher rates of both in males suggest that greater RRT initiation rate is biological rather than due to preferential treatment. Similar progression but very different RRT initiation rates in Stage 3 and 4 CKD suggests that CKD stage effect on RRT initiation is a function of endpoint proximity rather than faster renal function deterioration.

KW - chronic kidney disease

KW - cohort

KW - progression

KW - renal replacement therapy

KW - risk-factors

KW - CKD

KW - epidemiology

KW - outcomes

KW - decline

KW - cost

KW - care

KW - GFR

KW - Glomerular Filtration Rate

KW - renal insufficiency, chronic

U2 - 10.1093/ndt/gft393

DO - 10.1093/ndt/gft393

M3 - Article

C2 - 24081862

SN - 0931-0509

VL - 29

SP - 333

EP - 341

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 2

ER -

Definitions of progression in chronic kidney disease-predictors and relationship to renal replacement therapy in a population cohort with a 6 year follow-up

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Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS)

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