title: Self-rated health and adverse events in CKD.
abstract: OBJECTIVE
  Little is known about the utility of self-rated general health assessments in persons with moderate-to-severe CKD. This study examined the ability of a single self-rated health measure to predict all-cause mortality and kidney disease progression in a cohort of 443 patients with stages 3-4 CKD, recruited between 2005 and 2011, and followed until the end of 2012. The performance of models incorporating self-rated health measures was compared with previously published predictive models and more complex models comprising a multibiomarker panel.
  
  
  METHODS
  Participants were asked "In general, would you say your health is excellent, very good, good, fair, or poor?" Outcomes examined were time to all-cause mortality, kidney disease progression (initiation of RRT or 30% loss of eGFR), and a composite of these events. Model performances were compared using a nonparametric area under the curve (AUC) analysis.
  
  
  RESULTS
  Over a median follow-up of 3.3 years, 118 (27%) participants died and 138 (31%) had progression of kidney disease. Fair-to-poor self-rated health status was associated with significantly greater risks of mortality (fully adjusted hazard ratio [HR] for relative to good-to-excellent self-rated health, 2.76; 95% confidence interval [95% CI], 1.28 to 5.89), kidney disease progression (HR, 1.94; 95% CI, 1.49 to 2.56), and the combined end point (HR, 2.21; 95% CI, 1.66 to 2.96). For 3-year mortality prediction, the self-rated health model (AUC, 0.80; 95% CI, 0.76 to 0.85) had significantly higher AUCs than the base model (AUC, 0.71; 95% CI, 0.66 to 0.76) and the multibiomarker panel model (AUC, 0.74; 95% CI, 0.68 to 0.80) (P=0.03 and P=0.04, respectively).
  
  
  CONCLUSIONS
  A single, easily obtained measure of self-rated health helps identify patients with CKD at high risk of mortality and kidney disease progression. Routine evaluation of self-rated health may help target individuals who might benefit from more intensive monitoring strategies.
authors.affiliation: Kidney Research Institute, Department of Epidemiology, and cassyrc@uw.edu.
authors.forename: Cassianne
authors.initials: C
authors.lastname: Robinson-Cohen
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Yoshio N
authors.initials: YN
authors.lastname: Hall
authors.affiliation: Kidney Research Institute.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Rivara
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Kestenbaum
authors.affiliation: Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
mesh_terms: D000136:Acid-Base Equilibrium; D000368:Aged; D000419:Albuminuria / Q000652:urine; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D018450:Disease Progression; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood; D005500:Follow-Up Studies; D060730:Glomerular Filtration Barrier; D006304:Health Status; D006305:Health Status Indicators; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D017582:Renal Replacement Therapy; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014527:Uric Acid / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D006454:Hemoglobins; D010281:Parathyroid Hormone; D014807:Vitamin D; D014527:Uric Acid; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D; D003404:Creatinine
keywords: CKD; ESRD; clinical epidemiology; mortality risk; progression of chronic renal failure