title: Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study.
abstract: BACKGROUND
  Various indicators of progression of chronic kidney disease (CKD) have been used as outcomes in clinical research studies. The effect of using varying measures on the association of risk factors with CKD progression has not been well characterized.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The Chronic Renal Insufficiency Cohort (CRIC) Study (N=3,939) enrolled men and women with mild to moderate CKD, 48% of whom had diabetes and 42% were self-reported black race.
  
  
  METHODS
  Age, race, sex, diabetes, baseline estimated glomerular filtration rate (eGFR), proteinuria, and other established CKD risk factors.
  
  
  RESULTS
  Death, end-stage renal disease (ESRD), and eGFR events, including: (1) eGFR halving, (2) eGFR<15mL/min/1.73m(2), (3) eGFR halving and <15mL/min/1.73m(2), (4) eGFR decrease of 20mL/min/1.73m(2), (5) eGFR halving or decrease of 20mL/min/1.73m(2), and (6) eGFR decrease of 25% and change in CKD stage.
  
  
  RESULTS
  Mean entry eGFR was 44.9mL/min/1.73m(2). Annual rates of death, ESRD, and eGFR halving were 2.5%, 4.0%, and 6.1%, respectively, during an average follow-up of 5.4 years. Associations between risk factors and ESRD and eGFR events were similar across different definitions. However, these associations were substantially different from those with death. HRs for ESRD, eGFR halving, and death in the highest compared to the lowest proteinuria category were 11.83 (95% CI, 8.40-16.65), 11.19 (95% CI, 8.53-14.68), and 1.47 (95% CI, 1.10-1.96), respectively.
  
  
  CONCLUSIONS
  Participants may not be representative of the entire CKD population.
  
  
  CONCLUSIONS
  Using ESRD or eGFR events, but not death, in the definition of kidney disease outcomes is appropriate in follow-up studies to identify risk factors for CKD progression.
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: weiyang@mail.med.upenn.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Anderson
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Teal
authors.affiliation: University of California at San Francisco, San Francisco, CA.
authors.forename: Chi-yuan
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: University of Maryland, Baltimore, MD.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.affiliation: Tulane University, New Orleans, LA.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: University of Illinois at Chicago, Chicago, IL.
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
authors.affiliation: University of Michigan, Ann Arbor, MI.
authors.forename: Akinlolu
authors.initials: A
authors.lastname: Ojo
authors.affiliation: Case Western Reserve University, Cleveland, OH.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Nessel
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chronic Renal Insufficiency Cohort (CRIC); Kidney disease progression; chronic kidney disease (CKD); decreased estimated glomerular filtration rate (eGFR); disease trajectory; end-stage renal disease (ESRD); estimated glomerular filtration rate (eGFR); longitudinal outcome; mortality risk; renal function