title: Competing risk of death and end-stage renal disease in incident chronic kidney disease (stages 3 to 5): the EPIRAN community-based study.
abstract: Although chronic kidney disease (CKD) affects a growing number of people, epidemiologic data on incident CKD in the general population are scarce. Screening strategies to increase early CKD detection have been developed.
  
  
  
  From a community-based sample of 4,409 individuals residing in a well-defined geographical area, we determined the number of patients having a first serum creatinine value ≥1.7 mg/dL and present for at least 3 months that allowed us to calculate an annual incidence rate of CKD (stages 3 to 5). CKD (stages 3 to 5) was defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. We also described the primary care, outcomes and risk factors associated with outcomes using competing risks analyses for these CKD patients.
  
  
  
  A total of 631 incident CKD patients (stages 3 to 5) were followed-up until the occurrence of death and dialysis initiation for more than 3 years. The annual incidence rate of CKD (stages 3 to 5) was estimated at 977.7 per million inhabitants. Analyses were performed on 514 patients with available medical data. During the study, 155 patients (30.2 %) were referred to a nephrologist, 193 (37.5 %) died and 58 (11.3 %) reached end-stage renal disease and initiated dialysis. A total of 139 patients (27.6 %) had a fast decline of their renal function, 92 (18.3 %) a moderate decline and the 272 remaining patients had a physiological decline (21.1 %) or a small improvement of their renal function (33.0 %). Predictors of death found in both Cox and Fine-Gray multivariable regression models included age at diagnosis, anemia, active neoplasia and chronic heart failure, but not a low glomerular filtration rate (GFR). Age at diagnosis, anemia and a low GFR were independently associated with dialysis initiation in Cox model, but anemia was not found to be a risk factor for dialysis initiation in Fine-Gray model.
  
  
  
  This large cohort study provided useful epidemiological data on incident CKD (stages 3 to 5) and stressed the need to improve the hands-on implementation of clinical practice guidelines for the evaluation and the management of CKD in primary care.
authors.affiliation: INSERM, CIC-EC 1433, Nancy, France.|Pôle S2R, Epidemiology and clinical evaluation, University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Ayav
authors.affiliation: Geriatric Department, University Hospital, Lille, France.|Department of Biostatistics, UDSL, Lille, EA2694, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Beuscart
authors.affiliation: INSERM, CIC-EC 1433, Nancy, France.|Pôle S2R, Epidemiology and clinical evaluation, University Hospital, Vandoeuvre-les-Nancy, France.|Lorraine University, Paris Descartes University, Apemac, Nancy, EA4360, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Briançon
authors.affiliation: Department of Biostatistics, UDSL, Lille, EA2694, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Lorraine University, Paris Descartes University, Apemac, Nancy, EA4360, France.|Department of Nephrology, University Hospital, Vandœuvre-les-Nancy, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
authors.affiliation: Department of Nephrology, University Hospital, Vandœuvre-les-Nancy, France. m.kessler@chru-nancy.fr.
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality / Q000639:trends; D012111:Residence Characteristics; D012307:Risk Factors
keywords: Chronic kidney disease; Competing-risk analysis; Epidemiological study; Incidence; Outcomes; Risk factors