Abstract
BackgroundThe relevance of the cause of kidney disease to prognosis among patients with chronic kidney disease is uncertain.Study DesignObservational study.Settings & Participants6,245 nondialysis participants in the Study of Heart and Renal Protection (SHARP).PredictorBaseline cause of kidney disease was categorized into 4 groups: cystic kidney disease, diabetic nephropathy, glomerulonephritis, and other recorded diagnoses.OutcomesEnd-stage renal disease (ESRD; dialysis or transplantation) and death.ResultsDuring an average 4.7 years' follow-up, 2,080 participants progressed to ESRD, including 454 with cystic kidney disease (23% per year), 378 with glomerulonephritis (10% per year), 309 with diabetic nephropathy (12% per year), and 939 with other recorded diagnoses (8% per year). By comparison with patients with cystic kidney disease, other disease groups had substantially lower adjusted risks of ESRD (relative risks of 0.28 [95% CI, 0.24-0.32], 0.40 [95% CI, 0.34-0.47], and 0.29 [95% CI, 0.25-0.32] for glomerulonephritis, diabetic nephropathy, and other recorded diagnoses, respectively). Albuminuria and baseline estimated glomerular filtration rate were associated more weakly with risk of ESRD in patients with cystic kidney disease than the 3 other diagnostic categories (P for interaction, <0.001 and 0.01, respectively). Death before ESRD was uncommon in patients with cystic kidney disease, but was a major competing risk for participants with diabetic nephropathy, whose adjusted risk of death was 2-fold higher than that of the cystic kidney disease group (relative risk, 2.35 [95% CI, 1.73-3.18]).LimitationsExclusion of patients with prior myocardial infarction or coronary revascularization.ConclusionsThe cause of kidney disease has substantial prognostic implications. Other things being equal, patients with cystic kidney disease are at much higher risk of ESRD (and much lower risk of death before ESRD) than other patients. Patients with diabetic nephropathy are at particularly high risk of death prior to reaching ESRD.
Highlights
There were 6245 patients not on dialysis at randomisation, but 255 had missing values for renal diagnosis and so have been excluded from all further analyses. §The group of 3380 participants with ''other recorded diagnoses'' included 993 with hypertensive disease, 404 with pyelonephritis, 1197 with other known diagnosis, and 786 with no known cause. *Variables updated at 1 year for patients originally allocated simvastatin only who were rerandomised to simvastatin plus ezetimibe or placebo. †Percentages exclude participants for whom data were not available for that category
Effect of adjustment for known risk factors on the association between cause of kidney disease and death, estimated using Cox regression
Summary
Data are n (%), mean (SD), or median (IQR). There were 6245 patients not on dialysis at randomisation, but 255 had missing values for renal diagnosis and so have been excluded from all further analyses. §The group of 3380 participants with ''other recorded diagnoses'' included 993 with hypertensive disease, 404 with pyelonephritis, 1197 with other known diagnosis, and 786 with no known cause. *Variables updated at 1 year for patients originally allocated simvastatin only who were rerandomised to simvastatin plus ezetimibe or placebo. Baseline characteristics by renal diagnosis, among 5990 patients not on dialysis at randomisation and with a classified baseline cause of renal disease contd
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