Kidney Disease Stage Research Articles

Proper report of estimated glomerular filtration rate in clinical laboratory

Estimated glomerular filtration rate(eGFR) is important for diagnosis and staging of chronic kidney disease(CKD), disease risk evaluation and prediction of prognosis, precise dosing and public health management. Automatic reporting eGFR when creatinine and/or cystatin C is measured could improve the quality of service of clinical laboratory. Here we discussed the clinical significance of automatic reporting of eGFR, the status of automatic reporting of eGFR at home and abroad, and matters needing attention when eGFR was reported by clinical laboratory.Wish eGFR to play a better role in clinical practice.(Chin J Lab Med, 2016, 39: 887-890) Key words: Rena insufficiency, chronic; Glomerular filtration rate; Creatinine

Serum levels of RBP4 might not be determined by diabetes mellitus but by kidney function and renal replacement therapy

It has been reported that retinol-binding protein 4 (RBP4) is associated to adiposity, insulin resistance, and type 2 diabetes. Meanwhile, circulating RBP4 levels are also affected by renal function. The aim of the present study is to investigate whether serum levels of RBP4 are primarily associated with different stages of chronic kidney disease (CKD) or type 2 diabetes, if there is more potential relevance between RBP4 and renal replacement therapy. The serum levels of RBP4 were assessed by commercial competitive enzyme-linked immunosorbent assay (ELISA) kit in 212 patients with the CKD stages 1—5 and in 24 healthy controls, while its correlation with clinical and metabolic parameters was analyzed. The serum level of RBP4 had a strong correlation with estimated glomerular filtration rate (eGFR) (P 0.05 for all]. The elevation of RBP4 become higher in HD than in PD and ND in CKD5 patients (P = 0.008 and P = 0.04, respectively), while there was no significant difference between PD and ND groups. Multivariate linear regression analysis demonstrated three independent predictors of eGFR (β = −0.676, P < 0.001), C-reactive protein (CRP) (β = −0.573, P < 0.001) and creatine (β = 0.509, P = 0.024) in the study population. The study results demonstrated that the serum level of RBP4 was negatively related to the eGFR, whether diabetes mellitus (DM) affected the blood concentration of RBP4 or not. And the serum level of RBP4 exhibited significant difference in different renal replacement therapies.

Evolving therapies for hepatitis C virus in chronic kidney disease: the beginning of a new era.

The current review highlights recent advances in treatment of chronic hepatitis C virus infection using new classes of agents, direct-acting antivirals (DAAs), with a focus on the evidence for their use in the setting of chronic kidney disease (CKD) stages 4-5, hemodialysis, and kidney transplantation. DAA agents target-specific proteins involved in the hepatitis C virus life cycle and interrupt viral replication. Sustained virologic response, a marker of viral eradication, occurs in more than 90% of patients treated with DAA agents in the general population. Emerging data demonstrate similar sustained virologic response rates for specific DAA-based regimens in patients with CKD stages 4-5, hemodialysis patients, and kidney-transplant recipients. High sustained virologic response rates are seen with DAA agents in CKD populations. A thoughtful approach to the timing of treatment is required to facilitate timely access to kidney transplantation.

Effects of TORC1 Inhibition during the Early and Established Phases of Polycystic Kidney Disease

The disease-modifying effects of target of rapamycin complex 1 (TORC1) inhibitors during different stages of polycystic kidney disease (PKD) are not well defined. In this study, male Lewis Polycystic Kidney Disease (LPK) rats (a genetic ortholog of human NPHP9, phenotypically characterised by diffuse distal nephron cystic growth) and Lewis controls received either vehicle (V) or sirolimus (S, 0.2 mg/kg by intraperitoneal injection 5 days per week) during the early (postnatal weeks 3 to 10) or late stages of disease (weeks 10 to 20). In early-stage disease, sirolimus reduced kidney enlargement (by 63%), slowed the rate of increase in total kidney volume (TKV) in serial MRI by 78.2% (LPK+V: 132.3±59.7 vs. LPK+S: 28.8±12.0% per week) but only partly reduced the percentage renal cyst area (by 19%) and did not affect the decline in endogenous creatinine clearance (CrCl) in LPK rats. In late-stage disease, sirolimus reduced kidney enlargement (by 22%) and the rate of increase in TKV by 71.8% (LPK+V: 13.1±6.6 vs. LPK+S: 3.7±3.7% per week) but the percentage renal cyst area was unaltered, and the CrCl only marginally better. Sirolimus reduced renal TORC1 activation but not TORC2, NF-κB DNA binding activity, CCL2 or TNFα expression, and abnormalities in cilia ultrastructure, hypertension and cardiac disease were also not improved. Thus, the relative treatment efficacy of TORC1 inhibition on kidney enlargement was consistent at all disease stages, but the absolute effect was determined by the timing of drug initiation. Furthermore, cystic microarchitecture, renal function and cardiac disease remain abnormal with TORC1 inhibition, indicating that additional approaches to normalise cellular dedifferentiation, inflammation and hypertension are required to completely arrest the progression of PKDs.

GW27-e0094 The Predictive Value of Arterial Stiffness on Major Adverse Cardiovascular Events in Individuals with Mild Impaired Renal Function

Despite growing evidence that arterial stiffness has important predictive value on cardiovascular diseases (CVD) for patients with advanced stages of chronic kidney disease, the predictive significance of arterial stiffness in individuals with mild impaired renal function has not been established.

Symptom Management in Patients with Stage 5 CKD Opting for Conservative Management.

Chronic kidney disease (CKD) stages 3–5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms. An alternative option for these patients is to choose conservative management (CM) of their stage 5 CKD. These patients often have complex supportive and palliative care needs. The frequency, severity and distress caused by symptoms related to stage 5 CKD are often under recognized and under treated. There is a need for early identification and management of symptoms as they present in patients with stage 5 CKD being managed conservatively. Symptom assessment should be focused on anticipating, identifying and alleviating any symptoms. This needs to be incorporated into the regular practice of those managing CM patients.

Can We Further Improve the Quality of Nephro-Urological Care in Children with Myelomeningocele?

Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1.73 m2 accordingly. Median of frequency of urinary tract infections (fUTI): 1.2 episodes/year. In 24 children: low-pressure, in 30 children: high-pressure bladder was noted. Vesicouretral reflux (VUR) was noted in 23 children (42.6%). fUTI were more common in high-grade VUR group. High-grade VURs were more common in group of patients with severe renal damage. At the end of the survey 11.1% children were qualified to higher stages of chronic kidney disease. Renal parenchyma damage progression in RS was noted in 22.2% children. Positive VUR history, febrile recurrent UTIs, bladder wall trabeculation, and older age of the patients constitute risk factors of abnormal renal scans. More than 2.0 febrile, symptomatic UTIs annually increase by 5.6-fold the risk of severe renal parenchyma damage after five years.

Cardiac status in patients of chronic kidney disease: an assessment by non-invasive tools

Background: Chronic Renal Insufficiency is a major public health problem. Cardiovascular Disease is the leading cause of morbidity and mortality in patients at every stage of Chronic Kidney Disease. There is a 10-200 fold increased risk of cardiovascular disease in those with Chronic Kidney Disease compared to the age and sex matched with general population, depending on the stage of Chronic Kidney Disease. Objective: The objective of the study was to see correlation, if any, of cardiac status and stage of kidney disease. Materials and methods: The study was conducted at M. M. Institute of Medical Sciences and Research, Mullana, Ambala. Thirty patients of Chronic Kidney Disease were included in the study. Chronic Kidney Disease is defined as kidney damage lasting for more than 3 months characterised by structural or functional abnormalities of the kidney, with or without decreased Glomerular Filtration Rate (GFR), according to the K/DOQI Guidelines. Inclusion criteria were based on symptomatology and clinical history of features suggestive of Chronic Kidney Disease. Symptoms, Signs and history of the patients were used to filter out patients who did not fit in the criteria and selected patients on the basis of criteria were further evaluated and investigated. All patients were subjected to detailed history and clinical examination. Patients with age &lt;20 years, with history of Diabetes Mellitus, Dyslipidemia, Intrinsic Diseases of Ventricles, Congenital Heart Disease and chronic smokers were excluded from the study. A standard 12 lead ECG was done in all cases. Echocardiography was done in ECHO lab of Cardiology unit in MMIMSR. Echocardiographic assessment was done by using Model vivid Colour Doppler Echocardiography machine of GE make. Apical four chamber view was employed to obtain the measurements of Left ventricular volume in diastole and systole, Ejection fraction; Left Ventricular Indices were assessed and then were used to calculate Left Ventricular Mass by using the cube formula proposed by Devereux. Patients included in the study were treated as per the standard treatment schedule. The data obtained was analysed with appropriate statistical analysis tools at the end of the study and conclusive evidence was derived. Results: In the present study the mean Left Ventricular Mass was 249.76 ± 69.35 gms with 73% study cases having Left Ventricular Mass more than the reference range, also Left Ventricular Mass showed a progressive rise with increase in S. Creatinine levels. In the present study, Left Ventricular dysfunction was seen in nearly half of the cases while approximately one-fourth cases (23%) also had Systolic Dysfunction. Pericardial Effusion was also observed in 10 % the study cases in the present study.Conclusion: Cardiac functions particularly Left Ventricular parameters. Left Ventricular free wall thickness and Left Ventricular Mass being common abnormality in CKD patients.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.207-215

Evaluation of mortality and readmissions following hospitalization with heart failure

Objective: To examine the association of patient/clinical characteristics with mortality and readmission following a heart failure (HF)-related hospitalization.Research design and methods: Claims data, linked to laboratory, race/ethnicity, and mortality data, from a large US health plan were utilized to identify individuals with ≥1 inpatient claim with a diagnosis code for HF (1 January 2008–30 September 2012). Study variables were analyzed using descriptive and multivariable approaches to identify patient/clinical characteristics associated with post-discharge outcomes.Main outcome measures: Primary outcomes included post-discharge mortality and readmission.Results: A total of 126,214 individuals were identified with a HF-related hospitalization; 19.1% with data to calculate chronic kidney disease (CKD) stage. For the overall sample, mortality probability was 4.9% and 13.4% at 1 and 6 months post-discharge, respectively (4.5% and 12.4% for subset with calculated CKD stage), while readmission (all-cause) probability was 14.8% and 39.6% at 1 and 6 months post-discharge, respectively (18.4% and 44.5% for subset with calculated CKD stage). Within the subset with calculated CKD stage, mortality and readmission probabilities differed by CKD stage (p < 0.001), with decreased renal function corresponding with increased risk of mortality and readmission. After multivariable adjustment, increasing age was associated with increased risk of mortality, while advancing CKD stage, various index hospitalization variables (i.e., pre-admission emergency room visit, intensive care unit during hospitalization), and baseline all-cause hospitalization were associated with both increased risk of mortality and all-cause 1 month readmission.Conclusions: Calculated CKD, various index hospitalization variables, and baseline all-cause hospitalization were associated with increased risk of mortality and all-cause 1 month readmission among patients hospitalized with HF. Risk of post-discharge readmission and mortality increased with worse renal function, suggesting that improved management of this subset may reduce the burden and cost of this disease. Key study limitations include those related to retrospective claims-based studies and that renal function data were available for a subset of study patients.

Estimated GFR (eGFR) by prediction equation in staging of chronic kidney disease compared to gamma camera GFR

Background: Glomerular filtration rate is an effective tool for diagnosis and staging of chronic kidney disease. The effect ofrenal insufficiency by different method of this tool among patients with CKD is controversial.Objective: The objec­tive of this study was to evaluate the performance of eGFR in staging of CKD compared to gamma camera based GFR.Methods: This cross sectional analytical study was conducted in the Department of Biochemistry Bangabandhu Sheikh Mujib Medical University (BSMMU) with the collaboration with National Institute of Nuclear Medicine and Allied Sciences, BSMMU during the period of January 2011 to December 2012. Gama camera based GFR was estimated from DTP A reno gram and eGFR was estimated by three prediction equations. Comparison was done by Bland Altman agree­ment test to see the agreement on the measurement of GFR between three equation based eGFR method and gama camera based GFR method. Staging comparison was done by Kappa analysis to see the agreement between the stages identified by those different methods.Results: Bland-Altman agreement analysis between GFR measured by gamma camera, CG equation ,CG equation corrected by BSA and MDRD equation shows statistically significant. CKD stages determined by CG GFR, CG GFR corrected by BSA , MDRD GFR and gamma camera based GFR was compared by Kappa statistical analysis .The kappa value was 0.66, 0.77 and 0.79 respectively.Conclusions: This study findings suggest that GFR estimation by MDRD equation in CKD patients shows good agreement with gamma camera based GFR and for staging of CKD patients, eGFR by MDRD formula may be used as very effective tool in Bangladeshi population.

Help your patients have their say: Kidney Research UK patient survey

Patient involvement is crucial to how kidney research is carried out. With its upcoming 2016 patient survey, Kidney Research UK is now keen to find out what people living with kidney disease think are the most important areas for future research. Angela Lumsdon discusses how the charity is working with patients to find out what matters most to people at different stages of kidney disease.

PrEFiNe Plan: Strategic plan for Fabry's diseases in Nephrology

BackgroundRenal failure is one of the main causes of death in patients with Fabry disease (FD). Due to the low prevalence of FD, delayed diagnosis and misdiagnosis, often the correct diagnosis is made when organ damage is already present. Early recognition of the disease would allow the prevention of severe complications and the premature death of patients with FD. ObjectiveWe present here the PrEFiNE project, which includes a wide spectrum of activities with the aim of improve knowledge and diagnosis of FD.The project is sponsored by Shire Iberia (http://shireiberica.com/). MethodsFrom January 2016 to the end of 2017 several activities will be carried out, starting with a survey to evaluate current FD knowledge among nephrologists; in addition some studies to assess prevalence of this disease will be performed. One study will include patients receiving dialysis, another study will cover kidney transplant patients, and a pilot study in chronic kidney disease in stage 3–5 predialysis. Also planned is a pharmacoeconomic study to focus on burden of FD. At the same time medical education activities will be conducted both on line and on site. Plan for dissemination will include medical publications and diffusion to media. PrEFiNE Project will finish with the publication of a compilation book on FD in Nephrology including all planned activities and proposing recommendations based on results and detected unmet needs.PrEfiNE Plan will be coordinated by severa scientific committees, one at national level and 10 other regionals committees, that will be responsible to ensure the maximum scientific quality of proposed activities. An advisory board will supervise the project. DiscussionPrEfiNE project will evaluate an action plan focused on improving FD knowledge to make necessary recommendations for an early recognition of the disease. In addition will generate a plan to improve previously undetected needs.

Study of interrelation of I/D polymorphism in ace gene with a stage of chronic kidney disease in children and teenagers of Uzbek population with D1 according to guidelines K/DOQI (2012)

Study of interrelation of I/D polymorphism in ace gene with a stage of chronic kidney disease in children and teenagers of Uzbek population with D1 according to guidelines K/DOQI (2012)

Plan PrEFiNE: Plan estratégico para la enfermedad de Fabry en Nefrología

BackgroundRenal failure is one of the main causes of death in patients with Fabry disease (FD). Due to the low prevalence of FD, delayed diagnosis and misdiagnosis, often the correct diagnosis is made when organ damage is already present. Early recognition of the disease would allow the prevention of severe complications and the premature death of patients with FD. ObjectiveWe present here the PrEFiNE project, which includes a wide spectrum of activities with the aim of improve knowledge and diagnosis of FD.The project is sponsored by Shire Iberia (http://shireiberica.com/) MethodsFrom January 2016 to the end of 2017 several activities will be carried out, starting with a survey to evaluate current FD knowledge among nephrologists; in addition some studies to assess prevalence of this disease will be performed. One study will include patients receiving dialysis, another study will cover kidney transplant patients, and a pilot study in chronic kidney disease in stage 3-5 predialysis. Also planned is a pharmacoeconomic study to focus on burden of FD. At the same time medical education activities will be conducted both on line and on site. Plan for dissemination will include medical publications and diffusion to media. PrEFiNE Project will finish with the publication of a compilation book on FD in Nephrology including all planned activities and proposing recommendations based on results and detected unmet needs.PrEfiNE Plan will be coordinated by severa scientific committees, one at national level and 10 other regionals comittees, tha will be responsible to ensure the maximum scientific quality of proposed activities. An advisory board will supervise the project. DiscussionPrEfiNE project will evaluate an action plan focused on improving FD knowledge to make necessary recommendations for an early recognition of the disease. In addition will generate a plan to improve previously undetected needs.

Insuficienţa cardiacă cronică şi boala cronică de rinichi

Introduction. Renal dysfunction is one of the most common comorbidity of heart failure and may complicate its evolution. Aim. To analyze the frequency of chronic kidney disease in patients with decompensated chronic heart failure hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest over a period of one year. Material and method. We retrospectively analyzed the data registered in hospital’s database between June 1st, 2014 – June 1st, 2015. Between 01.06.2014-01.06.2015, 609 patients with the diagnosis of chronic heart failure were hospitalized. Of these, 109 (17.89%) were diagnosed with chronic kidney disease (CKD) and represented our group of study. Distribution of chronic kidney disease in patients with chronic heart failure, depending on the stage of chronic kidney disease, was: no patient with stage 1, 26.61% with stage 2, 33.94% with stage 3A, 28.44% in stage 3B, 8.26% with stage 4 and 2.75% with stage 5. Distribution of NYHA class in the study group was: 20.18% NYHA class II, 40.37% NYHA class III, 39, 45% NYHA IV. 37 of the 109 patients (33.94%) with chronic heart failure and CKD had type 2 diabetes. Other important comorbidities in the group of study have been hypertension and anemia. Conclusions. Most patients with chronic heart failure admitted to our clinic were men, had heart failure NYHA class III and presented CKD class 3. A significant proportion of patients had risk factors for both BRC and heart failure: essential hypertension, diabetes and anemia.

Risk factors for early renal dysfunction following endovascular aortic aneurysm repair and its effect on the postoperative outcome.

Renal insufficiency is associated with increased morbidity and death after endovascular aortic aneurysm repair (EVAR). However, the effect of postoperative acute kidney dysfunction on patient outcome has not been fully determined. This study aimed to determine the risk factors of early postoperative renal function decline using chronic kidney disease (CKD) staging and its effect on the clinical outcome. A retrospective analysis was performed on a prospectively maintained EVAR database. Pre- and postoperative CKD stages were determined for all patients according to the estimated glomerular filtration rate values. We identified 135 patients who were treated with elective EVAR. CKD stage decline was observed in 25 (19%) of the patients. Freedom from aneurysm-related death was significantly lower in patients with postoperative CKD progression compared with those with unchanged CKD stage. A shaggy aorta without oral beta-blocker administration and higher preoperative serum creatinine levels (>1.4mg/dL) were found to be independent predictors of an early postoperative CKD stage decline. Patients with postoperative CKD progression have an increased frequency of aneurysm-related death. The presence of a shaggy aorta, absence of oral beta-blocker administration and an increased preoperative creatinine level are independent predictors of early postoperative CKD progression.

The prognostic factors and predictive model of non-muscle invasive upper tract urothelial carcinoma: a survival analysis based on follow up over 5 years

Objective to evaluate the prognostic factors of non-muscle invasive upper tract urothelial carcinoma (NMIUTUC) and construct prognostic model for Chinese patients. Methods A retrospective study including 253 patients who were diagnosed with NMIUTUC in our hospital and received Radical nephroureterectomy (RNU) or partial ureterectomy during January of 2000 to December of 2013. Of all the 253 patients, 100 were male and 153 were female, average age was 67 (range: 25-90), 244 received RNU and 9 received partial ureterectomy. Results The median follow-up time was 55 (range: 4-151) months, and during follow-up, 40 (15.8%) patients were died for cancer, 84 (33.2%) patients developed intravesical recurrence. The independent prognostic factors of cancer-specific mortality were lymph nodes metastasis (P=0.046), main tumor locate in pelvis (P=0.044), ipsilateral hydronephrosis (P=0.039), higher chronic kidney disease (CKD) stage (P=0.008) and male gender (P=0.034), while patients with multifocality tumor or ipsilateral hydronephrosis more likely developed intravesical recurrence. Conclusion NMIUTUC has a better cancer-specific survival, the intravesical recurrence was equivalent to UTUC but later. Lymph nodes metastasis, main tumor locate in pelvis, ipsilateral hydronephrosis, CKD stage and male gender independently associated with cancer-specific mortality, while patients with multifocality tumor or ipsilateral hydronephrosis more likely developed intravesical recurrence. Key words: Non-muscle invasive upper tract urothelial carcinoma; Survival analysis; Prognostic factor; Nomogram

COMPLICATIONS AND OUTCOMES OF PREGNANCY IN CHRONIC KIDNEY DISEASE

Pregnancy in women with kidney disorders, even with preserved renal function, is associated with higher than in the population rates of obstetric and perinatal complications, such as eclampsia, preterm delivery, surgical deliveries and intensive care for newborns. This article presents our own data on complications and outcomes of pregnancies in 156 women with various stages of chronic kidney disease (CKD). From these, 87 patients had CKD stage I, 29 with CKD stage II and 40 with CKD stages III, IV, V. For the first time in Russia, the authors summarize their unique experience in management of pregnancy with CKD, underline a high probability (27,5%) of its primary detection during pregnancy, discuss the algorithms of assessment, prevention and treatment of various gestational complications in CKD (pre-eclampsia, urinary tract infections, feto-placental insufficiency, anemia, acute renal damage), as well as the influence of pregnancy on renal function at long-term post-delivery. A direct correlation between the CKD stage, frequency of pre-eclampsia, feto-placental insufficiency, preterm deliveries, surgical deliveries by caesarean section and babies’ status at birth is demonstrated. Based on their ample clinical material, they confirmprobability of favorable pregnancy outcomes in CKD patients with stable renal function without severe arterial hypertension during pregnancy: for a baby in 87%, for the mother in 90% (maintenance of the same CKD stage). The risk of persistent deterioration of renal function during pregnancy and puerperium in women with CKD is higher in CKD stage IV, as well as in the case of early development of pre-eclampsia; it also correlates with severity of the latter. The probability of a favorable obstetric and nephrological outcome is higher when the pregnancy is planned and intensively co-managed by an obstetrician/gynaecologist and a nephrologist from early weeks of gestation onwards.

Prevalence of Hyperparathyroidism, Mineral and Bone Disorders in Children with Advanced Chronic Kidney Disease.

To identify the prevalence and risk factors for secondary hyperparathyroidism in children with advanced stages of chronic kidney disease (CKD). A retrospective cross-sectional observational study of clinical and laboratory data of pediatric patients with CKD stage 3, 4 was conducted from 2005 through 2013 at a single center in the Kingdom of Saudi Arabia. One hundred nineteen children (60.5% boys) with mean age of 10.1±5.1 y were included in the study. The mean eGFR (estimated Glomerular Filtration Rate) was 18.3 ± 15.4 ml/min/1.73m(2) and the mean intact parathyroid hormone (iPTH) level was 62.2 ± 89.4 pmol/L. Patients with a high iPTH had lower eGFR than those who were euparathyroid (16 ± 13.4 vs. 29.7 ± 19ml/min/1.73m(2), respectively; p = 0.006), had lower calcium levels (2.2 ± 0.3 vs. 2.4 ± 0.3 mmol/L; p = 0.03) and a lower bicarbonate level (21.2 ± 4.2 vs. 23.3 ± 3.2 mmol/L; p = 0.04). Three children with hyperparthyrodism (4.9 %) had fractures, 16 (26.2 %) had bone deformities compared to 5 in the euoparathyroid group (p=0.012). Parathyroid hormone negatively correlated with the patient's eGFR (r=-0.55), serum calcium (r=-0.43), and positively correlated with serum phosphate (r=0.38). The single most important predictor of hyperparathyroidism in children in the present sample was eGFR.

Novel Stratification of Mortality Risk by Kidney Disease Stage

Background: Chronic kidney disease (CKD) is a common disorder with a variable clinical course and it is associated with increased mortality. The Intermountain Risk Score (IMRS) is an electronic risk calculator that utilizes complete blood count (CBC) and basic metabolic panel (BMP) values to predict mortality in various healthcare populations. We hypothesized that IMRS would predict mortality in patients with CKD even with adjustment for serum phosphate and urinary albumin. Methods: Three thousand eight hundred seventy-two patients with CKD classes IIIA-V had IMRS calculated retrospectively and survival analysis was performed investigating 1- and 5-year mortality. Kaplan-Meier survival curves were generated for predefined IMRS groups of low, medium and high risk for CKD patients overall and by sex and CKD stage. Serum phosphate and urinary albumin/creatinine ratios were modeled in multivariate Cox-proportional hazard models. Receiver operator characteristic curves were used to determine c-statistics for mortality. Results: For all patients with CKD, mortality was significantly greater for those with medium- or high-risk compared to low-risk IMRS categories, among each CKD stage. Overall, IMRS was predictive of mortality at both 1 and 5 years, even when adjusted for CKD stage and predicted mortality more accurately than CKD stage alone. Albuminuria was not independently associated with mortality and serum phosphate weakly predicted mortality. Conclusion: IMRS is a strong predictor of mortality in patients with CKD and is robustly complementary to CKD stage in refining risk prediction. Given the universal availability and low cost of the CBC and BMP, IMRS may be of a substantial value in CKD risk assessment and management.