Rate of Kidney Function Decline Associates with Mortality
The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to...
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| Veröffentlicht in: | Journal of the American Society of Nephrology 2010-11, Vol.21 (11), p.1961-1969 |
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| container_end_page | 1969 |
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| container_issue | 11 |
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| container_title | Journal of the American Society of Nephrology |
| container_volume | 21 |
| creator | AL-ALY, Ziyad ZERINGUE, Angelique ABBOTT, Kevin C EISEN, Seth FU, John RAUCHMAN, Michael I MCDONALD, Jay R EL-ACHKAR, Tarek M BALASUBRAMANIAN, Sumitra NURUTDINOVA, Diana HONG XIAN STROUPE, Kevin |
| description | The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the definition of CKD may transform a static definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual. |
| doi_str_mv | 10.1681/ASN.2009121210 |
| format | Article |
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Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the definition of CKD may transform a static definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual.</description><identifier>ISSN: 1046-6673</identifier><identifier>EISSN: 1533-3450</identifier><identifier>DOI: 10.1681/ASN.2009121210</identifier><identifier>PMID: 20947634</identifier><identifier>CODEN: JASNEU</identifier><language>eng</language><publisher>Washington, DC: American Society of Nephrology</publisher><subject>Aged ; Aged, 80 and over ; Arthritis, Rheumatoid - epidemiology ; Arthritis, Rheumatoid - mortality ; Arthritis, Rheumatoid - physiopathology ; Biological and medical sciences ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - physiopathology ; Chronic Disease ; Clinical Epidemiology ; Cohort Studies ; Comorbidity ; Diabetes Mellitus - epidemiology ; Diabetes Mellitus - mortality ; Diabetes Mellitus - physiopathology ; Disease Progression ; Female ; Glomerular Filtration Rate - physiology ; Humans ; Hypertension - epidemiology ; Hypertension - mortality ; Hypertension - physiopathology ; Kidney - physiopathology ; Kidney Diseases - diagnosis ; Kidney Diseases - mortality ; Kidney Diseases - physiopathology ; Longitudinal Studies ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate</subject><ispartof>Journal of the American Society of Nephrology, 2010-11, Vol.21 (11), p.1961-1969</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 by the American Society of Nephrology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-308e94e12a4fe0a4816e2025f25091ad67ca4e7a47828a68f586530424307a193</citedby><cites>FETCH-LOGICAL-c419t-308e94e12a4fe0a4816e2025f25091ad67ca4e7a47828a68f586530424307a193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014010/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014010/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23376736$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20947634$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>AL-ALY, Ziyad</creatorcontrib><creatorcontrib>ZERINGUE, Angelique</creatorcontrib><creatorcontrib>ABBOTT, Kevin C</creatorcontrib><creatorcontrib>EISEN, Seth</creatorcontrib><creatorcontrib>FU, John</creatorcontrib><creatorcontrib>RAUCHMAN, Michael I</creatorcontrib><creatorcontrib>MCDONALD, Jay R</creatorcontrib><creatorcontrib>EL-ACHKAR, Tarek M</creatorcontrib><creatorcontrib>BALASUBRAMANIAN, Sumitra</creatorcontrib><creatorcontrib>NURUTDINOVA, Diana</creatorcontrib><creatorcontrib>HONG XIAN</creatorcontrib><creatorcontrib>STROUPE, Kevin</creatorcontrib><title>Rate of Kidney Function Decline Associates with Mortality</title><title>Journal of the American Society of Nephrology</title><addtitle>J Am Soc Nephrol</addtitle><description>The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the definition of CKD may transform a static definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthritis, Rheumatoid - epidemiology</subject><subject>Arthritis, Rheumatoid - mortality</subject><subject>Arthritis, Rheumatoid - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular Diseases - physiopathology</subject><subject>Chronic Disease</subject><subject>Clinical Epidemiology</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diabetes Mellitus - mortality</subject><subject>Diabetes Mellitus - physiopathology</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Glomerular Filtration Rate - physiology</subject><subject>Humans</subject><subject>Hypertension - epidemiology</subject><subject>Hypertension - mortality</subject><subject>Hypertension - physiopathology</subject><subject>Kidney - physiopathology</subject><subject>Kidney Diseases - diagnosis</subject><subject>Kidney Diseases - mortality</subject><subject>Kidney Diseases - physiopathology</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Rate</subject><issn>1046-6673</issn><issn>1533-3450</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc1LAzEQxYMotlavHmUv4mnr5GOT3YtQqlWxKvhxDmOatZHtRjdbpf-9kdZWyWEC85s3jzeEHFLoU5nT08HjXZ8BFJTFB1ukSzPOUy4y2I5_EDKVUvEO2QvhDYBmTKld0mFQCCW56JLiAVub-DK5cZPaLpLRvDat83Vybk3lapsMQvDGRSgkX66dJre-abFy7WKf7JRYBXuwqj3yPLp4Gl6l4_vL6-FgnBpBizblkNtCWMpQlBZQ5FRaBiwrWRZd40Qqg8IqFCpnOcq8zHKZcRBMcFBIC94jZ0vd9_nLzE6MrdsGK_3euBk2C-3R6f-d2k31q__UHKgAClHgZCXQ-I-5Da2euWBsVWFt_TxoJaMfBpRFsr8kTeNDaGy53kJB_8StY9x6E3ccOPrrbY3_5huB4xWAwWBVNlgbFzYc5yqeR_Jv9xuGKg</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>AL-ALY, Ziyad</creator><creator>ZERINGUE, Angelique</creator><creator>ABBOTT, Kevin C</creator><creator>EISEN, Seth</creator><creator>FU, John</creator><creator>RAUCHMAN, Michael I</creator><creator>MCDONALD, Jay R</creator><creator>EL-ACHKAR, Tarek M</creator><creator>BALASUBRAMANIAN, Sumitra</creator><creator>NURUTDINOVA, Diana</creator><creator>HONG XIAN</creator><creator>STROUPE, Kevin</creator><general>American Society of Nephrology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20101101</creationdate><title>Rate of Kidney Function Decline Associates with Mortality</title><author>AL-ALY, Ziyad ; ZERINGUE, Angelique ; ABBOTT, Kevin C ; EISEN, Seth ; FU, John ; RAUCHMAN, Michael I ; MCDONALD, Jay R ; EL-ACHKAR, Tarek M ; BALASUBRAMANIAN, Sumitra ; NURUTDINOVA, Diana ; HONG XIAN ; STROUPE, Kevin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-308e94e12a4fe0a4816e2025f25091ad67ca4e7a47828a68f586530424307a193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthritis, Rheumatoid - epidemiology</topic><topic>Arthritis, Rheumatoid - mortality</topic><topic>Arthritis, Rheumatoid - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular Diseases - physiopathology</topic><topic>Chronic Disease</topic><topic>Clinical Epidemiology</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diabetes Mellitus - mortality</topic><topic>Diabetes Mellitus - physiopathology</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Glomerular Filtration Rate - physiology</topic><topic>Humans</topic><topic>Hypertension - epidemiology</topic><topic>Hypertension - mortality</topic><topic>Hypertension - physiopathology</topic><topic>Kidney - physiopathology</topic><topic>Kidney Diseases - diagnosis</topic><topic>Kidney Diseases - mortality</topic><topic>Kidney Diseases - physiopathology</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>AL-ALY, Ziyad</creatorcontrib><creatorcontrib>ZERINGUE, Angelique</creatorcontrib><creatorcontrib>ABBOTT, Kevin C</creatorcontrib><creatorcontrib>EISEN, Seth</creatorcontrib><creatorcontrib>FU, John</creatorcontrib><creatorcontrib>RAUCHMAN, Michael I</creatorcontrib><creatorcontrib>MCDONALD, Jay R</creatorcontrib><creatorcontrib>EL-ACHKAR, Tarek M</creatorcontrib><creatorcontrib>BALASUBRAMANIAN, Sumitra</creatorcontrib><creatorcontrib>NURUTDINOVA, Diana</creatorcontrib><creatorcontrib>HONG XIAN</creatorcontrib><creatorcontrib>STROUPE, Kevin</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>AL-ALY, Ziyad</au><au>ZERINGUE, Angelique</au><au>ABBOTT, Kevin C</au><au>EISEN, Seth</au><au>FU, John</au><au>RAUCHMAN, Michael I</au><au>MCDONALD, Jay R</au><au>EL-ACHKAR, Tarek M</au><au>BALASUBRAMANIAN, Sumitra</au><au>NURUTDINOVA, Diana</au><au>HONG XIAN</au><au>STROUPE, Kevin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rate of Kidney Function Decline Associates with Mortality</atitle><jtitle>Journal of the American Society of Nephrology</jtitle><addtitle>J Am Soc Nephrol</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>21</volume><issue>11</issue><spage>1961</spage><epage>1969</epage><pages>1961-1969</pages><issn>1046-6673</issn><eissn>1533-3450</eissn><coden>JASNEU</coden><abstract>The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the definition of CKD may transform a static definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual.</abstract><cop>Washington, DC</cop><pub>American Society of Nephrology</pub><pmid>20947634</pmid><doi>10.1681/ASN.2009121210</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Arthritis, Rheumatoid - epidemiology Arthritis, Rheumatoid - mortality Arthritis, Rheumatoid - physiopathology Biological and medical sciences Cardiovascular Diseases - epidemiology Cardiovascular Diseases - mortality Cardiovascular Diseases - physiopathology Chronic Disease Clinical Epidemiology Cohort Studies Comorbidity Diabetes Mellitus - epidemiology Diabetes Mellitus - mortality Diabetes Mellitus - physiopathology Disease Progression Female Glomerular Filtration Rate - physiology Humans Hypertension - epidemiology Hypertension - mortality Hypertension - physiopathology Kidney - physiopathology Kidney Diseases - diagnosis Kidney Diseases - mortality Kidney Diseases - physiopathology Longitudinal Studies Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Prognosis Retrospective Studies Risk Factors Survival Rate |
| title | Rate of Kidney Function Decline Associates with Mortality |
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