title: Prognosis of CKD patients receiving outpatient nephrology care in Italy.
abstract: OBJECTIVE
  Prognosis in nondialysis chronic kidney disease (CKD) patients under regular nephrology care is rarely investigated. Design, setting, participants, & measurements We prospectively followed from 2003 to death or June 2010 a cohort of 1248 patients with CKD stages 3 to 5 and previous nephrology care ≥1 year in 25 Italian outpatient nephrology clinics. Cumulative incidence of ESRD or death before ESRD were estimated using the competing-risk approach.
  
  
  RESULTS
  Estimated rates (per 100 patient-years) of ESRD and death 8.3 (95% confidence interval [CI], 7.4 to 9.2) and 5.9 (95% CI 5.2 to 6.6), respectively. Risk of ESRD and death increased progressively from stages 3 to 5. ESRD was more frequent than death in stage 4 and 5 CKD, whereas the opposite was true in stage 3 CKD. Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD, whereas older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and anemia predicted death (P < 0.05 for all). Among modifiable risk factors, proteinuria accounted for the greatest contribution to the model fit for either outcome.
  
  
  CONCLUSIONS
  In patients receiving continuity of care in Italian nephrology clinics, ESRD was a more frequent outcome than death in stage 4 and 5 CKD, but the opposite was true in stage 3. Outcomes were predicted by modifiable risk factors specific to CKD. Proteinuria used in conjunction with estimated GFR refined risk stratification. These findings provide information, specific to CKD patients under regular outpatient nephrology care, for risk stratification that complement recent observations in the general population.
authors.affiliation: Nephrology Division, University of Naples, Naples, Italy. luca.denicola@unina2.it
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: Silvio
authors.initials: S
authors.lastname: Borrelli
authors.forename: Bruno
authors.initials: B
authors.lastname: Cianciaruso
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
authors.forename: Domenico
authors.initials: D
authors.lastname: Santoro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Giancaspro
authors.forename: Cataldo
authors.initials: C
authors.lastname: Abaterusso
authors.forename: Ciro
authors.initials: C
authors.lastname: Gallo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data; D017711:Nonlinear Dynamics; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome