title: Progressive chronic kidney disease in primary care: modifiable risk factors and predictive model.
abstract: OBJECTIVE
  To determine the incidence and prevalence of CKD and of progressive GFR decline, to identify modifiable risk factors of and to develop a predictive risk model for progressive GFR decline in high risk primary care patients.
  
  
  METHODS
  Retrospective observational study of 803 patients with or at high risk of CKD exclusively managed in primary care. Baseline data was collected in 2003, follow-up data in 2006. High risk was defined as inadequately controlled hypertension or diabetes, and GFR<60, progressive GFR decline as annual GFR decline >2.5mlmin(-1) 1.73m(-2).
  
  
  RESULTS
  CKD was present in 25.4% at baseline and developed in further 13.7% during follow-up, 42.5% demonstrated progressive GFR decline. Obesity, proteinuria, heart failure, inadequate hypertension and diabetes control, lacking angiotensin-converting-enzyme-inhibitors or angiotensin-receptor-blockers, radio contrast, and dual renin-angiotensin-aldosterone-system blockade were identified as modifiable, independent risk factors of progressive GFR decline. The risk model, containing 7 readily obtainable variables, showed good discriminative ability.
  
  
  CONCLUSIONS
  High risk primary care patients demonstrated high CKD prevalence and incidence, and rate of progressive GFR decline. Identified risk factors can be modified in primary care. Our risk model may aid primary care physicians to predict patients at high risk of progressive GFR decline.
authors.affiliation: Department of Medicine, Rotes Kreuz Krankenhaus, 28199 Bremen, Germany; Department of Nephrology, University Hospital, University Duisburg-Essen, 45122 Essen, Germany. Electronic address: herget-rosenthal.s@roteskreuzkrankenhaus.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Herget-Rosenthal
authors.forename: Dorothea
authors.initials: D
authors.lastname: Dehnen
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.forename: Thomas
authors.initials: T
authors.lastname: Quellmann
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D011507:Proteinuria / Q000150:complications / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Chronic kidney disease; Incidence; Prediction; Prevalence; Primary care; Progression; Risk factor