title: Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization.
abstract: BACKGROUND
  Chronic kidney disease is the primary cause of end-stage renal disease in the United States. The purpose of this study was to understand the natural history of chronic kidney disease with regard to progression to renal replacement therapy (transplant or dialysis) and death in a representative patient population.
  
  
  METHODS
  In 1996 we identified 27 998 patients in our health plan who had estimated glomerular filtration rates of less than 90 mL/min per 1.73 m(2) on 2 separate measurements at least 90 days apart. We followed up patients from the index date of the first glomerular filtration rates of less than 90 mL/min per 1.73 m(2) until renal replacement therapy, death, disenrollment from the health plan, or June 30, 2001. We extracted from the computerized medical records the prevalence of the following comorbidities at the index date and end point: hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, hyperlipidemia, and renal anemia.
  
  
  RESULTS
  Our data showed that the rate of renal replacement therapy over the 5-year observation period was 1.1%, 1.3%, and 19.9%, respectively, for the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) stages 2, 3, and 4, but that the mortality rate was 19.5%, 24.3%, and 45.7%. Thus, death was far more common than dialysis at all stages. In addition, congestive heart failure, coronary artery disease, diabetes, and anemia were more prevalent in the patients who died but hypertension prevalence was similar across all stages.
  
  
  CONCLUSIONS
  Our data suggest that efforts to reduce mortality in this population should be focused on treatment and prevention of coronary artery disease, congestive heart failure, diabetes mellitus, and anemia.
authors.affiliation: Division of Nephrology and Hypertension, Oregon Health and Science University, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Keith
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.forename: Christina M
authors.initials: CM
authors.lastname: Gullion
authors.forename: Jonathan Betz
authors.initials: JB
authors.lastname: Brown
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D017582:Renal Replacement Therapy; D016896:Treatment Outcome