title: Epidemiological study of chronic kidney disease progression: a large-scale population-based cohort study.
abstract: The prognostic information about CKD progression, particularly for GFR categories 1 and 2, is still limited. This cohort was therefore conducted to determine the CKD progression using a competing risk approach. We conducted a retrospective cohort study linking community health screening with hospitals and death registry data in a province of Thailand, from 1997 to 2011. A competing risk model was applied by treating death as a competing risk factor to estimate 2-, 5-, and 10-year probability of kidney failure and median time for CKD progression from lower to higher GFR category. There were 17,074 non-diabetic and 15,032 diabetic CKD subjects. Diabetic subjects progressed more rapidly through GFR categories with the median times for CKD progression from GFR categories G1 to G2, G2 to G3a, G3a to G3b, G3b to G4, and G4 to G5 of 4.4, 6.1, 4.9, 6.3, and 9.0 years, respectively. Non-diabetic subjects took longer to progress with the corresponding median time of 9.4, 14.0, 11.0, 13.8, and >14.3 years. After adjusting for confounders, diabetic subjects were 49% (cause-specific hazard ratio ((c)HR) = 1.49, 95% CI: 1.37, 1.62) more likely to develop kidney failure than non-diabetic subjects. Albuminuria categories A3 and A2 were, respectively, 3.40 (95% CI: 3.07, 3.76) and 1.71 (95% CI: 1.53, 1.92) higher risk of kidney failure when compared to A1. For each albumin category, death rate increased as albuminuria increased particularly in diabetic subjects, which was approximately 2 times higher in A3 compared to A1. Considering GFR category, it gradually increased from G1 to G4 and sharply increased from G4 to G5 in both non-diabetic and diabetic subjects. This study has quantified CKD progression in an Asian population within ordinary practice. Diabetic subjects progress through GFR and albuminuria categories and reach kidney failure about twice as rapidly as non-diabetic subjects.
authors: From the Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (PV, AI, AT); Department of Medicine, Bundarik Hospital, Bundarik District, Ubon Ratchathani Province, Thailand (PV); and Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, NSW, Australia (JA).
authors: Phisitt
authors: P
authors: Vejakama
authors: Atiporn
authors: A
authors: Ingsathit
authors: John
authors: J
authors: Attia
authors: Ammarin
authors: A
authors: Thakkinstian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000145:classification / Q000453:epidemiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D012737:Sex Factors; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
references: Am J Kidney Dis. 2003 Oct;42(4):677-84
references: 14520617
references: Am J Kidney Dis. 2010 Jan;55(1):31-41
references: 19932544
references: Ren Fail. 2014 Jul;36(6):838-46
references: 24673339
references: Clin Exp Nephrol. 2008 Oct;12(5):363-369
references: 18584288
references: Stat Med. 1999 Mar 30;18(6):681-94
references: 10204197
references: Stat Med. 2007 May 20;26(11):2389-430
references: 17031868
references: Stat Med. 1991 Apr;10(4):585-98
references: 2057657
references: BMJ. 2010 Sep 30;341:c4986
references: 20884698
references: Nephrol Dial Transplant. 2010 Dec;25(12):3836-9
references: 20833688
references: J Ren Nutr. 2001 Jan;11(1):16-22
references: 11172449
references: Lancet. 2008 Jun 28;371(9631):2173-82
references: 18586172
references: Int J Epidemiol. 2012 Jun;41(3):861-70
references: 22253319
references: Stat Med. 2007 Mar 15;26(6):1360-7
references: 16900575
references: JAMA. 2010 Feb 3;303(5):423-9
references: 20124537
references: JAMA. 2007 Nov 7;298(17):2038-47
references: 17986697
references: Stat Med. 2011 Feb 20;30(4):377-99
references: 21225900
references: J Am Soc Nephrol. 2006 Mar;17(3):846-53
references: 16452492
references: Kidney Int. 2009 Sep;76(6):629-37
references: 19516247
references: N Engl J Med. 2004 Sep 23;351(13):1296-305
references: 15385656
references: BMC Med Res Methodol. 2010 Oct 21;10:97
references: 20964855
references: Medicine (Baltimore). 2014 Aug;93(7):e41
references: 25101985
references: Am J Epidemiol. 2009 Jul 15;170(2):244-56
references: 19494242
references: J Am Soc Nephrol. 2014 Sep;25(9):2088-96
references: 24652789
references: J Am Soc Nephrol. 2005 Feb;16(2):489-95
references: 15590763
references: BMJ. 2013 Jan 31;346:f462
references: 23369775
references: Arch Intern Med. 2004 Mar 22;164(6):659-63
references: 15037495
references: Nephrol Dial Transplant. 2010 May;25(5):1567-75
references: 20037182
references: Am J Kidney Dis. 2012 Mar;59(3):390-9
references: 22115883
references: Nephrol Dial Transplant. 2013 Nov;28(11):2670-7
references: 23975843
references: Ann Intern Med. 2009 May 5;150(9):604-12
references: 19414839
references: Kidney Int. 2007 Aug;72(3):247-59
references: 17568785
references: BMC Nephrol. 2013 May 24;14:110
references: 23705871