Incident chronic kidney disease: trends in management and outcomes.
BACKGROUND
Management trends in early chronic kidney disease (CKD) and their associations with clinical outcomes have not previously been reported.


METHODS
We evaluated incident (Stage G3A) CKD patients from an integrated health care system in 2004-06, 2007-09 and 2010-12 to determine adjusted trends in screening (urinary protein quantification), treatment [prescription for angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and statin] and nephrology referral. For the same time periods, adjusted rates for mortality, progression to Stage G4 CKD and hospitalization for myocardial infarction or heart failure were calculated and compared across time periods.


RESULTS
There were 728, 788 and 956 patients with incident CKD in 2004-06, 2007-09 and 2010-12, respectively. Adjusted rates of proteinuria quantification (31, 39 and 51 screens/100 person-years), statin prescription (53, 63 and 64 prescriptions/100 person-years) and nephrology referral (2, 3 and 5 referrals/100 person-years) all increased over time (P for trend <0.001 in all cases). ACEI/ARB prescription rates did not change (88, 83 and 80 prescriptions/100 person-years, P = 0.68). Adjusted death rates (7, 5 and 6 deaths/100 person-years), CKD progression (9, 10 and 7 progressors/100 person-years) and cardiovascular hospitalization (10, 8 and 9 hospitalizations per 100/person-years) did not change (P for trend >0.4 in all cases).


CONCLUSIONS
In this integrated health care system, management of incident CKD over the past decade has intensified.
Bayer HealthCare , Whippany, NJ , USA.
Robert M
RM
Perkins
Bayer HealthCare , Whippany, NJ , USA.
Alex R
AR
Chang
Geisinger Medical Center , Danville, PA , USA.
Kenneth E
KE
Wood
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University , Baltimore, MD , USA.
Josef
J
Coresh
Johns Hopkins Bloomberg School of Public Health , Baltimore, MD , USA.
Kunihiro
K
Matsushita
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University , Baltimore, MD , USA.
Morgan
M
Grams
cardiovascular; chronic renal insufficiency; epidemiology; proteinuria; renin-angiotensin system