Lifetime Risk of Stage 3-5 CKD in a Community-Based Sample in Iceland.
OBJECTIVE
Lifetime risk estimates of CKD can be used effectively in public education campaigns. This study sought to estimate lifetime risk of incident CKD stage 3 and higher in Iceland for people without CKD by the age of 45 years.


METHODS
This was a prospective cohort study with longitudinal creatinine measurements of residents in Reykjavik, Iceland, from 1967 to 2005. CKD was ascertained by two consecutive eGFR measurements <60 ml/min per 1.73 m(2), development of treated kidney failure, one eGFR<60 ml/min per 1.73 m(2) if the participant died before the next evaluation, or one eGFR<45 ml/min per 1.73 m(2) if it was the last eGFR.


RESULTS
Mean follow-up was 25 (SD 10) years. Of the study participants, 727 (19%) developed the outcome and 942 (24%) died first. By age 85 years, the lifetime risks for 45-year-old women and men without prevalent CKD were 35.8% (95% confidence interval [95% CI], 32.7 to 38.9) and 21.3% (95% CI, 18.7 to 23.8), respectively. Risk was higher in individuals with a lower eGFR, hypertension, and a higher body mass index. Lifetime risk for higher stages of CKD 3b and 4 were less common than stage 3a; by age 85 years, the lifetime risks for CKD stages 3a, 3b, and 4 in women were 38.5% (95% CI, 25.8 to 51.1), 19.4% (95% CI, 8.9 to 29.9), and 3.6% (95% CI, 2.2 to 5.0), respectively.


CONCLUSIONS
The lifetime risk of developing CKD stage 3 or higher is substantial, emphasizing the importance of strategies to prevent development of CKD throughout the course of life. Estimates are lower than reported using single estimates of GFR, emphasizing the importance of confirming estimates of reduced GFR in studies of CKD.
Division of Nephrology and linker@tuftsmedicalcenter.org.
Lesley A
LA
Inker
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts;
Hocine
H
Tighiouart
Icelandic Heart Association, Kopavogur, Iceland; Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland;
Thor
T
Aspelund
Icelandic Heart Association, Kopavogur, Iceland; Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland;
Vilmundur
V
Gudnason
National Institute on Aging, Bethesda, Maryland;
Tamara
T
Harris
Division of Nephrology, Landspitali - National University Hospital of Iceland, Reykjavik, Iceland; and.
Olafur S
OS
Indridason
Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Nephrology, Landspitali - National University Hospital of Iceland, Reykjavik, Iceland; and.
Runolfur
R
Palsson
Division of Nephrology, University of Texas Southwestern, Dallas, Texas.
Shani
S
Shastri
Division of Nephrology and.
Andrew S
AS
Levey
Division of Nephrology and.
Mark J
MJ
Sarnak
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors
D003404:Creatinine
CKD; GFR; elderly; epidemiology and outcomes; lifetime risk