Outcomes of stage 3-5 chronic kidney disease before end-stage renal disease at a single center in Taiwan.
BACKGROUND
Taiwan has the highest incidence of end-stage renal disease (ESRD) in the world, but little is known about the outcomes of patients with chronic kidney disease (CKD) before ESRD in Taiwan. This study investigated the rate of renal progression and predictors for ESRD and death in a prospective cohort of patients under usual nephrologic care at a single center.


METHODS
A total of 433 patients at CKD stage 3-5 short of dialysis were recruited from nephrology clinics. Patients were monitored for up to 36 months or until ESRD, death or loss to follow-up. Glomerular filtration rates (GFR) were calculated by the Modification of Diet in Renal Disease abbreviated formula.


RESULTS
At baseline, mean age was 65.6 years, 61.7% were male, 33.3% were diabetic and 29.1% had cardiovascular diseases (CVD). At the end of follow-up, 123 patients (28.4%) had advanced to ESRD and 41 (9.5%) had died. Mean annual declines in GFR were 2.24, 4.22, and 3.23 ml/min/1.73 m(2) for stages 3, 4, and 5, respectively. By Cox regression model, patients with CVD, lower BMI and higher systolic BP were more likely to develop ESRD. Older patients with CVD and lower systolic BP were more likely to die.


CONCLUSIONS
In this CKD cohort, patients were more likely to develop ESRD than cardiovascular death. The rate of GFR decline and predictors of ESRD were comparable to those reported in Western countries. Thus, the high incidence of ESRD in Taiwan may be attributed, at least in part, to lower cardiovascular mortality.
Chiu
Yen-Ling
YL
Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei, Taiwan.
Chien
Kuo-Liong
KL
Lin
Shuei-Liong
SL
Chen
Yung-Ming
YM
Tsai
Tun-Jun
TJ
Wu
Kwan-Dun
KD
D000046:Academic Medical Centers / Q000639:trends*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome