title: Evaluating the contribution of the cause of kidney disease to prognosis in CKD: results from the Study of Heart and Renal Protection (SHARP).
abstract: BACKGROUND
  The relevance of the cause of kidney disease to prognosis among patients with chronic kidney disease is uncertain.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  6,245 nondialysis participants in the Study of Heart and Renal Protection (SHARP).
  
  
  METHODS
  Baseline cause of kidney disease was categorized into 4 groups: cystic kidney disease, diabetic nephropathy, glomerulonephritis, and other recorded diagnoses.
  
  
  RESULTS
  End-stage renal disease (ESRD; dialysis or transplantation) and death.
  
  
  RESULTS
  During an average 4.7 years' follow-up, 2,080 participants progressed to ESRD, including 454 with cystic kidney disease (23% per year), 378 with glomerulonephritis (10% per year), 309 with diabetic nephropathy (12% per year), and 939 with other recorded diagnoses (8% per year). By comparison with patients with cystic kidney disease, other disease groups had substantially lower adjusted risks of ESRD (relative risks of 0.28 [95% CI, 0.24-0.32], 0.40 [95% CI, 0.34-0.47], and 0.29 [95% CI, 0.25-0.32] for glomerulonephritis, diabetic nephropathy, and other recorded diagnoses, respectively). Albuminuria and baseline estimated glomerular filtration rate were associated more weakly with risk of ESRD in patients with cystic kidney disease than the 3 other diagnostic categories (P for interaction, <0.001 and 0.01, respectively). Death before ESRD was uncommon in patients with cystic kidney disease, but was a major competing risk for participants with diabetic nephropathy, whose adjusted risk of death was 2-fold higher than that of the cystic kidney disease group (relative risk, 2.35 [95% CI, 1.73-3.18]).
  
  
  CONCLUSIONS
  Exclusion of patients with prior myocardial infarction or coronary revascularization.
  
  
  CONCLUSIONS
  The cause of kidney disease has substantial prognostic implications. Other things being equal, patients with cystic kidney disease are at much higher risk of ESRD (and much lower risk of death before ESRD) than other patients. Patients with diabetic nephropathy are at particularly high risk of death prior to reaching ESRD.
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Haynes
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Natalie
authors.initials: N
authors.lastname: Staplin
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Emberson
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: William G
authors.initials: WG
authors.lastname: Herrington
authors.affiliation: North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Agodoa
authors.affiliation: First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tesar
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Christina
authors.initials: C
authors.lastname: Reith
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Baigent
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. Electronic address: sharpclinical@ctsu.ox.ac.uk.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Landray
mesh_terms: D000368:Aged; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D005921:Glomerulonephritis / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000150:complications* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis* / Q000209:etiology*; D012307:Risk Factors; D015996:Survival Rate
keywords: Kidney disease etiology; cystic kidney disease; disease progression; disease trajectory; end-stage renal disease (ESRD); prognosis; risk factor