title: Kidney Failure and ESRD in the Atherosclerosis Risk in Communities (ARIC) Study: Comparing Ascertainment of Treated and Untreated Kidney Failure in a Cohort Study.
abstract: BACKGROUND
  Linkage to the US Renal Data System (USRDS) registry commonly is used to identify end-stage renal disease (ESRD) cases, or kidney failure treated with dialysis or transplantation, but it underestimates the total burden of kidney failure. This study validates a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation. It compares kidney failure risk factors and outcomes using this broader definition with USRDS-identified ESRD risk factors and outcomes.
  
  
  METHODS
  Diagnostic test study with stratified random sampling of hospitalizations for chart review.
  
  
  METHODS
  Atherosclerosis Risk in Communities Study (n=11,530; chart review, n=546).
  
  
  METHODS
  USRDS-identified ESRD; treated or untreated kidney failure defined by USRDS-identified ESRD or International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification (ICD-9-CM/ICD-10-CM) code for hospitalization or death.
  
  
  METHODS
  For ESRD, determination of permanent dialysis therapy or transplantation; for kidney failure, determination of permanent dialysis therapy, transplantation, or estimated glomerular filtration rate < 15 mL/min/1.73 m(2).
  
  
  RESULTS
  During 13 years' median follow-up, 508 kidney failure cases were identified, including 173 (34.1%) from the USRDS registry. ESRD and kidney failure incidence were 1.23 and 3.66 cases per 1,000 person-years in the overall population and 1.35 and 6.59 cases per 1,000 person-years among participants older than 70 years, respectively. Other risk-factor associations were similar between ESRD and kidney failure, except diabetes and albuminuria, which were stronger for ESRD. Survivals at 1 and 5 years were 74.0% and 24.0% for ESRD and 59.8% and 31.6% for kidney failure, respectively. Sensitivity and specificity were 88.0% and 97.3% comparing the kidney failure ICD-9-CM/ICD-10-CM code algorithm to chart review; for USRDS-identified ESRD, sensitivity and specificity were 94.9% and 100.0%.
  
  
  CONCLUSIONS
  Some medical charts were incomplete.
  
  
  CONCLUSIONS
  A kidney failure definition including treated and untreated disease identifies more cases than linkage to the USRDS registry alone, particularly among older adults. Future studies might consider reporting both USRDS-identified ESRD and a more inclusive kidney failure definition.
authors.affiliation: Johns Hopkins University, Baltimore, MD. Electronic address: crebhol1@jhu.edu.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Rebholz
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Blaithin
authors.initials: B
authors.lastname: McMahon
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Seamus P
authors.initials: SP
authors.lastname: Whelton
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
mesh_terms: D000368:Aged; D000465:Algorithms; D016022:Case-Control Studies; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D038801:International Classification of Diseases; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: Atherosclerosis Risk in Communities (ARIC) Study; End-stage renal disease (ESRD); US Renal Data System (USRDS); chronic kidney disease (CKD); chronic kidney failure; hospitalization; renal replacement therapy (RRT); sensitivity and specificity; untreated renal failure; validation studies