Abstract
BackgroundAlthough chronic kidney disease (CKD) affects a growing number of people, epidemiologic data on incident CKD in the general population are scarce. Screening strategies to increase early CKD detection have been developed.MethodsFrom a community-based sample of 4,409 individuals residing in a well-defined geographical area, we determined the number of patients having a first serum creatinine value ≥1.7 mg/dL and present for at least 3 months that allowed us to calculate an annual incidence rate of CKD (stages 3 to 5). CKD (stages 3 to 5) was defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. We also described the primary care, outcomes and risk factors associated with outcomes using competing risks analyses for these CKD patients.ResultsA total of 631 incident CKD patients (stages 3 to 5) were followed-up until the occurrence of death and dialysis initiation for more than 3 years. The annual incidence rate of CKD (stages 3 to 5) was estimated at 977.7 per million inhabitants. Analyses were performed on 514 patients with available medical data. During the study, 155 patients (30.2 %) were referred to a nephrologist, 193 (37.5 %) died and 58 (11.3 %) reached end-stage renal disease and initiated dialysis. A total of 139 patients (27.6 %) had a fast decline of their renal function, 92 (18.3 %) a moderate decline and the 272 remaining patients had a physiological decline (21.1 %) or a small improvement of their renal function (33.0 %). Predictors of death found in both Cox and Fine-Gray multivariable regression models included age at diagnosis, anemia, active neoplasia and chronic heart failure, but not a low glomerular filtration rate (GFR). Age at diagnosis, anemia and a low GFR were independently associated with dialysis initiation in Cox model, but anemia was not found to be a risk factor for dialysis initiation in Fine-Gray model.ConclusionsThis large cohort study provided useful epidemiological data on incident CKD (stages 3 to 5) and stressed the need to improve the hands-on implementation of clinical practice guidelines for the evaluation and the management of CKD in primary care.
Highlights
Chronic kidney disease (CKD) affects a growing number of people, epidemiologic data on incident chronic kidney disease (CKD) in the general population are scarce
The objectives of the present community-based study was to determine the number of patients residing in a well-defined geographical area having a first serum creatinine value ≥1.7 mg/dL after January 1st, 2004 and still present for at least 3 months, and to describe their primary care, outcomes and risk factors associated with outcomes using competing risks analyses
Among the 4,409 individuals, 35 patients refused to be enrolled and 110 were excluded because of lack of a second creatinine measurement; 1,012 patients with a serum creatinine ≥1.7 mg/dL reported prior to January 1st 2004 were considered as prevalent CKD patients; 2,621 patients had an acute deterioration of renal function, and creatinine level lowered back to below 1.7 mg/dL during the follow-up; 631 were diagnosed incident CKD patients after validation by the expert committee (Fig. 1)
Summary
Study design EPIRAN (EPidémiologie de l’Insuffisance Rénale chronique dans l’Agglomération Nancéienne) was a communitybased epidemiological study based on active and passive data collection. 117 patients had missing data for all covariates except age, sex, and creatinine level, and were excluded in statistical analyses of secondary objectives. Dialysis initiation and kidney transplant were collected for all included patients from all three nephrology departments located in the UCGN and from the French Renal Epidemiology and Information Network (REIN) registry [26]. Statistical analyses The annual incidence rate of CKD (stages 3 to 5) in UCGN was estimated from the whole study cohort (N = 631). It was calculated using the general population estimates for a health service catchment area as the denominator, based on population estimates from the 1999 Census [28].
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