Chronic kidney disease and the risk of end-stage renal disease versus death.
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.
Dalrymple
Lorien S
LS
Department of Medicine, University of California Davis, 4150 V Street, #3500 PSSB, Sacramento, CA 95817, USA. lorien.dalrymple@ucdmc.ucdavis.edu
Katz
Ronit
R
Kestenbaum
Bryan
B
Shlipak
Michael G
MG
Sarnak
Mark J
MJ
Stehman-Breen
Catherine
C
Seliger
Stephen
S
Siscovick
David
D
Newman
Anne B
AB
Fried
Linda
L
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