Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999.
Knowledge of the excess risk posed by specific cardiovascular syndromes could help in the development of strategies to reduce premature mortality among patients with chronic kidney disease (CKD). The rates of atherosclerotic vascular disease, congestive heart failure, renal replacement therapy, and death were compared in a 5% sample of the United States Medicare population in 1998 and 1999 (n = 1,091,201). Patients were divided into the following groups: 1, no diabetes, no CKD (79.7%); 2, diabetes, no CKD (16.5%); 3, CKD, no diabetes (2.2%); and 4, both CKD and diabetes (1.6%). During the 2 yr of follow-up, the rates (per 100 patient-years) in the four groups were as follows: atherosclerotic vascular disease, 14.1, 25.3, 35.7, and 49.1; congestive heart failure, 8.6, 18.5, 30.7, and 52.3; renal replacement therapy, 0.04, 0.2, 1.6, and 3.4; and death, 5.5, 8.1, 17.7, and 19.9, respectively (P < 0.0001). With use of Cox regression, the corresponding adjusted hazards ratios were as follows: atherosclerotic vascular disease, 1, 1.30, 1.16, and 1.41 (P < 0.0001); congestive heart failure, 1, 1.44, 1.28, and 1.79 (P < 0.0001); renal replacement therapy, 1, 2.52, 23.1, and 38.9 (P < 0.0001); and death, 1, 1.21, 1.38, and 1.56 (P < 0.0001). On a relative basis, patients with CKD were at a much greater risk for the least frequent study outcome, renal replacement therapy. On an absolute basis, however, the high death rates of patients with CKD may reflect accelerated rates of atherosclerotic vascular disease and congestive heart failure.
Foley
Robert N
RN
United States Renal Data System Coordinating Center, 914 South 8th Street, Suite D-253, Minneapolis, MN 55404, USA. RFoley@usrds.org
Murray
Anne M
AM
Li
Shuling
S
Herzog
Charles A
CA
McBean
A Marshall
AM
Eggers
Paul W
PW
Collins
Allan J
AJ
D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002423:Cause of Death; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D006278:Medicare; D016017:Odds Ratio; D011336:Probability; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology