title: Chronic kidney disease and the risk of end-stage renal disease versus death.
abstract: BACKGROUND
  Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown.
  
  
  OBJECTIVE
  To compare the rates of ESRD, cardiovascular and non-cardiovascular death and examine risk factors for ESRD and all-cause mortality in Cardiovascular Health Study (CHS) participants.
  
  
  METHODS
  The CHS is a longitudinal cohort study of community-dwelling adults aged 65 years and older.
  
  
  METHODS
  1,268 participants with an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m(2) were followed until the time of first event (ESRD, cardiovascular or non-cardiovascular death) or until March 31, 2003.
  
  
  METHODS
  The outcomes were ESRD, cardiovascular- and non-cardiovascular death. Rates of each event were calculated, and a Cox Proportional Hazards Model with a competing risk framework was used to examine risk factors for ESRD as compared with death. Predictors included age, gender, race, BMI, hypertension, diabetes, cardiovascular disease, heart failure, tobacco use, eGFR, and total cholesterol.
  
  
  RESULTS
  During 9.7 years of follow-up, 5% of the cohort progressed to ESRD, and 61% of the cohort died. The rate (per 100 person-years) was 0.5 for ESRD and 6.8 for all-cause mortality (3.0 for cardiovascular and 3.8 for non-cardiovascular mortality). In the competing risk framework, lower eGFR, male gender, African-American race, and higher BMI were associated with an increased risk of ESRD.
  
  
  CONCLUSIONS
  Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.
authors.affiliation: Department of Medicine, University of California Davis, 4150 V Street, #3500 PSSB, Sacramento, CA 95817, USA. lorien.dalrymple@ucdmc.ucdavis.edu
authors.forename: Lorien S
authors.initials: LS
authors.lastname: Dalrymple
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: Catherine
authors.initials: C
authors.lastname: Stehman-Breen
authors.forename: Stephen
authors.initials: S
authors.lastname: Seliger
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Linda
authors.initials: L
authors.lastname: Fried
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome