Chronic kidney disease progression in a large prevention program in Colombia: A cohort study

Abstract

Background: Estimating morbidity outcomes and the rate of progression of chronic kidney disease (CKD) patients is of great importance for the health systems. Objective: The objective of this study is to estimate the incidence of dialysis initiation and the rate of CKD progression in 2 years follow-up and identify factors associated with dialysis starts. Methods: A retrospective cohort study of adult with diagnosed CKD stages-G3, G4 (estimated glomerular filtration rate between 60 and 15 ml/min/1.73 m2) enrolled into a CKD prevention program in Bogota-Colombia, since January 1, 2016, to June 30, 2017, with follow-up until June 30, 2019. Cohort’s outcomes were arrival to dialysis and stage G5, dropout of the program, hospitalization, and mortality. Repeated measurements of the estimation of glomerular filtration rate (eGFR) allowed us to estimate the change over time in 4-month periods using a mixed-effects model. An Extended Cox model was adjusted for the time to start dialysis. Results: One thousand four hundred forty-eight patients were included in the analysis; the incidence rate of dialysis initiation was 2.1 events per 100 patients-year (95% CI: 1.5 2.7). The mean of eGFR variation was +1.1 ml/min/1.73 m2/year; and for diabetics was −1.0 ml/min/m2/year. Being diabetic and having poorly controlled hypertension were significant risk factors for time to dialysis initiation. Conclusion: The incidence rates of dialysis initiation, dropout, and hospitalization are outcomes of significant interest in a CKD prevention program. Being diabetic and poor blood pressure control are risk factors for a more rapid progression to dialysis.