title: Risks of Adverse Events in Advanced CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study.
abstract: BACKGROUND
  People with advanced chronic kidney disease are at risk for the development of end-stage renal disease (ESRD), but also many other adverse outcomes, including cardiovascular disease (CVD) events and death. Determination of risk factors that explain the variability in prognosis and timing of these adverse outcomes can aid patient counseling and medical decision making.
  
  
  METHODS
  Prospective research cohort.
  
  
  METHODS
  1,798 participants with estimated glomerular filtration rates (eGFRs)<30mL/min/1.73m2in the CRIC Study were followed up for a median of 5.5 years.
  
  
  METHODS
  Age, race, sex, eGFR, proteinuria, diabetes mellitus, body mass index, ejection fraction, systolic blood pressure, history of CVD, and smoking history.
  
  
  RESULTS
  ESRD, CVD (congestive heart failure, stroke, myocardial infarction, and peripheral artery disease), and death.
  
  
  RESULTS
  Baseline age of the cohort was 60 years, 46% were women, and 46% were African American. Although 52.3% of participants progressed to ESRD during follow-up, the path by which this occurred was variable. For example, predicted 1-year probabilities for a hypothetical 60-year-old white woman with eGFR of 30mL/min/1.73m2, urine protein excretion of 1.8g/d, and no diabetes or CVD (risk characteristics similar to the average participant) were 3.3%, 4.1%, and 0.3%, for first developing CVD, ESRD, and death, respectively. For a 40-year-old African American man with similar characteristics but higher systolic blood pressure, the corresponding 1-year probabilities were 2.4%, 13.2%, and 0.1%. For all participants, the development of ESRD or CVD increased the risk for subsequent mortality, with no differences by patient race or body mass index.
  
  
  CONCLUSIONS
  The CRIC population was specifically recruited for kidney disease, and the vast majority had seen a nephrologist.
  
  
  CONCLUSIONS
  The prognosis and timing of adverse outcomes in chronic kidney disease vary by patient characteristics. These results may help guide the development of personalized approaches for managing patients with advanced CKD.
authors.affiliation: Division of Nephrology, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: mgrams2@jhmi.edu.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Rebholz
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Xue
authors.initials: X
authors.lastname: Wang
authors.affiliation: Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Porter
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Inker
authors.affiliation: Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Edward
authors.initials: E
authors.lastname: Horwitz
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI.
authors.forename: James H
authors.initials: JH
authors.lastname: Sondheimer
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
authors.forename: L Lee
authors.initials: LL
authors.lastname: Hamm
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.affiliation: Division of Nephrology, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, MD.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.affiliation: Division of Nephrology, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, MD.
authors.forename: Tariq
authors.initials: T
authors.lastname: Shafi
authors.affiliation: Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, MD; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.affiliation: Division of Nephrology, University of California, San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: CKD progression; CRIC (Chronic Renal Insufficiency Cohort); Chronic kidney disease (CKD); advanced CKD; adverse event; cardiovascular disease (CVD); disease trajectory; end-stage renal disease (ESRD); incident ESRD; kidney function decline; mortality; pre-ESRD death; prognosis; risk factor