Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease

Introduction: Understanding heterogeneity in the prognosis of chronic kidney disease (CKD) has implications in management of patients. We aimed to evaluate the comparative risk of end-stage kidney disease (ESKD), cardiovascular (CV) events, and death among patients with CKD in China. Methods: In tot...

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Autores principales:	Jinwei Wang, Jicheng Lv, Kevin He, Fang Wang, Bixia Gao, Ming-Hui Zhao, Luxia Zhang
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	all-cause mortality cardiovascular disease chronic kidney disease cohort end-stage kidney disease incidence rate Internal medicine RC31-1245
Acceso en línea:	https://doaj.org/article/4c60c7dde3994ccc9b2d8038fd11c4c9
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spelling	oai:doaj.org-article:4c60c7dde3994ccc9b2d8038fd11c4c92021-11-25T07:47:20ZLongitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease2296-93812296-935710.1159/000519190https://doaj.org/article/4c60c7dde3994ccc9b2d8038fd11c4c92021-10-01T00:00:00Zhttps://www.karger.com/Article/FullText/519190https://doaj.org/toc/2296-9381https://doaj.org/toc/2296-9357Introduction: Understanding heterogeneity in the prognosis of chronic kidney disease (CKD) has implications in management of patients. We aimed to evaluate the comparative risk of end-stage kidney disease (ESKD), cardiovascular (CV) events, and death among patients with CKD in China. Methods: In total, 3,700 patients with CKD stage 1–4 were recruited from 39 clinical centers in China between 2011 and 2016. New occurrence of ESKD, CV events, and all-cause mortality was recorded until the end of 2017. The crude incidence rate was calculated for each outcome. Ratios of incidence between different outcomes were generated with 95% confidence interval (CI) estimated by 1,000 times of bootstrapping. Multivariable adjusted Cox regression models accounting for competing risk between the outcomes were used to evaluate the association of risk factors with the outcomes. Results: The population mean age was 50 ± 14 years, with 58.2% male and 60.3% of glomerulonephritis. After a median follow-up of 4.65 years (interquartile range [IQR]: 3.71–5.60 years) for ESKD, 4.76 years (IQR: 3.97–5.76 years) for CV events, and 4.84 years (IQR: 3.97–5.76 years) for death, the incidence rates of the 3 outcomes were 3.1, 1.5, and 0.92/100 patient-years, respectively. The ratio for the incidence of ESKD and CV events was 2.15 (95% CI: 1.87, 2.53) and that for incidence of ESKD and death was 3.41 (95% CI: 2.88, 4.08). Significant differences regarding the ratios were detected through levels of age, history of CV disease, the estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (uACR), and etiology of CKD. In the Cox regression model adjusting for traditional CV and kidney-specific risk factors, older age was associated with a higher risk of CV events and death but a lower risk of ESKD (hazard ratios [HRs] = 1.45 [95% CI: 1.29, 1.64], 1.48 [95% CI: 1.29, 1.70], and 0.78 [95% CI: 0.73, 0.84] per 10 year increase, respectively). By comparison, reduced eGFR was associated with a higher risk of ESKD and death, rather than CV events (HRs = 3.62 [95% CI: 2.96, 4.43], 1.30 [95% CI: 1.02, 1.66], and 1.22 [95% CI: 0.99, 1.49] per 30.26 mL/min/1.73 m2 increase, respectively). Similar patterns were seen for increased uACR (HRs = 1.42 [95% CI: 1.30, 1.55], 1.17 [95% CI: 1.05, 1.30], and 1.07 [95% CI: 0.99, 1.17] per 1 natural log-transformed value increase, respectively). Conclusion: ESKD was more likely to occur than CV events and death in the population with CKD stage 1–4 in China. Traditional risk factors contributed differently to the comparative risk of the outcomes.Jinwei WangJicheng LvKevin HeFang WangBixia GaoMing-Hui ZhaoLuxia ZhangKarger Publishersarticleall-cause mortalitycardiovascular diseasechronic kidney diseasecohortend-stage kidney diseaseincidence rateInternal medicineRC31-1245ENKidney Diseases, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	all-cause mortality cardiovascular disease chronic kidney disease cohort end-stage kidney disease incidence rate Internal medicine RC31-1245
spellingShingle	all-cause mortality cardiovascular disease chronic kidney disease cohort end-stage kidney disease incidence rate Internal medicine RC31-1245 Jinwei Wang Jicheng Lv Kevin He Fang Wang Bixia Gao Ming-Hui Zhao Luxia Zhang Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease
description	Introduction: Understanding heterogeneity in the prognosis of chronic kidney disease (CKD) has implications in management of patients. We aimed to evaluate the comparative risk of end-stage kidney disease (ESKD), cardiovascular (CV) events, and death among patients with CKD in China. Methods: In total, 3,700 patients with CKD stage 1–4 were recruited from 39 clinical centers in China between 2011 and 2016. New occurrence of ESKD, CV events, and all-cause mortality was recorded until the end of 2017. The crude incidence rate was calculated for each outcome. Ratios of incidence between different outcomes were generated with 95% confidence interval (CI) estimated by 1,000 times of bootstrapping. Multivariable adjusted Cox regression models accounting for competing risk between the outcomes were used to evaluate the association of risk factors with the outcomes. Results: The population mean age was 50 ± 14 years, with 58.2% male and 60.3% of glomerulonephritis. After a median follow-up of 4.65 years (interquartile range [IQR]: 3.71–5.60 years) for ESKD, 4.76 years (IQR: 3.97–5.76 years) for CV events, and 4.84 years (IQR: 3.97–5.76 years) for death, the incidence rates of the 3 outcomes were 3.1, 1.5, and 0.92/100 patient-years, respectively. The ratio for the incidence of ESKD and CV events was 2.15 (95% CI: 1.87, 2.53) and that for incidence of ESKD and death was 3.41 (95% CI: 2.88, 4.08). Significant differences regarding the ratios were detected through levels of age, history of CV disease, the estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (uACR), and etiology of CKD. In the Cox regression model adjusting for traditional CV and kidney-specific risk factors, older age was associated with a higher risk of CV events and death but a lower risk of ESKD (hazard ratios [HRs] = 1.45 [95% CI: 1.29, 1.64], 1.48 [95% CI: 1.29, 1.70], and 0.78 [95% CI: 0.73, 0.84] per 10 year increase, respectively). By comparison, reduced eGFR was associated with a higher risk of ESKD and death, rather than CV events (HRs = 3.62 [95% CI: 2.96, 4.43], 1.30 [95% CI: 1.02, 1.66], and 1.22 [95% CI: 0.99, 1.49] per 30.26 mL/min/1.73 m2 increase, respectively). Similar patterns were seen for increased uACR (HRs = 1.42 [95% CI: 1.30, 1.55], 1.17 [95% CI: 1.05, 1.30], and 1.07 [95% CI: 0.99, 1.17] per 1 natural log-transformed value increase, respectively). Conclusion: ESKD was more likely to occur than CV events and death in the population with CKD stage 1–4 in China. Traditional risk factors contributed differently to the comparative risk of the outcomes.
format	article
author	Jinwei Wang Jicheng Lv Kevin He Fang Wang Bixia Gao Ming-Hui Zhao Luxia Zhang
author_facet	Jinwei Wang Jicheng Lv Kevin He Fang Wang Bixia Gao Ming-Hui Zhao Luxia Zhang
author_sort	Jinwei Wang
title	Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease
title_short	Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease
title_full	Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease
title_fullStr	Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease
title_full_unstemmed	Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease
title_sort	longitudinal follow-up and outcomes for chinese patients with stage 1–4 chronic kidney disease
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/4c60c7dde3994ccc9b2d8038fd11c4c9
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Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease

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