Prognosis of CKD Patients Receiving Outpatient Nephrology Care in Italy
Prognosis in nondialysis chronic kidney disease (CKD) patients under regular nephrology care is rarely investigated. Design, setting, participants, & measurements We prospectively followed from 2003 to death or June 2010 a cohort of 1248 patients with CKD stages 3 to 5 and previous nephrology ca...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2011-10, Vol.6 (10), p.2421-2428 |
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| creator | De Nicola, Luca Chiodini, Paolo Zoccali, Carmine Borrelli, Silvio Cianciaruso, Bruno Di Iorio, Biagio Santoro, Domenico Giancaspro, Vincenzo Abaterusso, Cataldo Gallo, Ciro Conte, Giuseppe Minutolo, Roberto |
| description | Prognosis in nondialysis chronic kidney disease (CKD) patients under regular nephrology care is rarely investigated. Design, setting, participants, & measurements We prospectively followed from 2003 to death or June 2010 a cohort of 1248 patients with CKD stages 3 to 5 and previous nephrology care ≥1 year in 25 Italian outpatient nephrology clinics. Cumulative incidence of ESRD or death before ESRD were estimated using the competing-risk approach.
Estimated rates (per 100 patient-years) of ESRD and death 8.3 (95% confidence interval [CI], 7.4 to 9.2) and 5.9 (95% CI 5.2 to 6.6), respectively. Risk of ESRD and death increased progressively from stages 3 to 5. ESRD was more frequent than death in stage 4 and 5 CKD, whereas the opposite was true in stage 3 CKD. Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD, whereas older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and anemia predicted death (P < 0.05 for all). Among modifiable risk factors, proteinuria accounted for the greatest contribution to the model fit for either outcome.
In patients receiving continuity of care in Italian nephrology clinics, ESRD was a more frequent outcome than death in stage 4 and 5 CKD, but the opposite was true in stage 3. Outcomes were predicted by modifiable risk factors specific to CKD. Proteinuria used in conjunction with estimated GFR refined risk stratification. These findings provide information, specific to CKD patients under regular outpatient nephrology care, for risk stratification that complement recent observations in the general population. |
| doi_str_mv | 10.2215/CJN.01180211 |
| format | Article |
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Estimated rates (per 100 patient-years) of ESRD and death 8.3 (95% confidence interval [CI], 7.4 to 9.2) and 5.9 (95% CI 5.2 to 6.6), respectively. Risk of ESRD and death increased progressively from stages 3 to 5. ESRD was more frequent than death in stage 4 and 5 CKD, whereas the opposite was true in stage 3 CKD. Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD, whereas older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and anemia predicted death (P < 0.05 for all). Among modifiable risk factors, proteinuria accounted for the greatest contribution to the model fit for either outcome.
In patients receiving continuity of care in Italian nephrology clinics, ESRD was a more frequent outcome than death in stage 4 and 5 CKD, but the opposite was true in stage 3. Outcomes were predicted by modifiable risk factors specific to CKD. Proteinuria used in conjunction with estimated GFR refined risk stratification. These findings provide information, specific to CKD patients under regular outpatient nephrology care, for risk stratification that complement recent observations in the general population.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.01180211</identifier><identifier>PMID: 21817127</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Aged ; Aged, 80 and over ; Ambulatory Care - statistics & numerical data ; Analysis of Variance ; Chi-Square Distribution ; Continuity of Patient Care - statistics & numerical data ; Disease Progression ; Female ; Glomerular Filtration Rate ; Humans ; Incidence ; Italy - epidemiology ; Kaplan-Meier Estimate ; Kidney Diseases - complications ; Kidney Diseases - diagnosis ; Kidney Diseases - mortality ; Kidney Diseases - physiopathology ; Kidney Diseases - therapy ; Kidney Failure, Chronic - etiology ; Kidney Failure, Chronic - mortality ; Male ; Middle Aged ; Nephrology - statistics & numerical data ; Nonlinear Dynamics ; Original ; Proportional Hazards Models ; Prospective Studies ; Proteinuria - etiology ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome</subject><ispartof>Clinical journal of the American Society of Nephrology, 2011-10, Vol.6 (10), p.2421-2428</ispartof><rights>Copyright © 2011 by the American Society of Nephrology 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-99dfa723043abfcfefffb241cb95dac1b17b27ef275a172c03383dd2cd26d2dc3</citedby><cites>FETCH-LOGICAL-c525t-99dfa723043abfcfefffb241cb95dac1b17b27ef275a172c03383dd2cd26d2dc3</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/PMC3359552/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359552/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21817127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De Nicola, Luca</creatorcontrib><creatorcontrib>Chiodini, Paolo</creatorcontrib><creatorcontrib>Zoccali, Carmine</creatorcontrib><creatorcontrib>Borrelli, Silvio</creatorcontrib><creatorcontrib>Cianciaruso, Bruno</creatorcontrib><creatorcontrib>Di Iorio, Biagio</creatorcontrib><creatorcontrib>Santoro, Domenico</creatorcontrib><creatorcontrib>Giancaspro, Vincenzo</creatorcontrib><creatorcontrib>Abaterusso, Cataldo</creatorcontrib><creatorcontrib>Gallo, Ciro</creatorcontrib><creatorcontrib>Conte, Giuseppe</creatorcontrib><creatorcontrib>Minutolo, Roberto</creatorcontrib><creatorcontrib>SIN-TABLE CKD Study Group</creatorcontrib><title>Prognosis of CKD Patients Receiving Outpatient Nephrology Care in Italy</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>Prognosis in nondialysis chronic kidney disease (CKD) patients under regular nephrology care is rarely investigated. Design, setting, participants, & measurements We prospectively followed from 2003 to death or June 2010 a cohort of 1248 patients with CKD stages 3 to 5 and previous nephrology care ≥1 year in 25 Italian outpatient nephrology clinics. Cumulative incidence of ESRD or death before ESRD were estimated using the competing-risk approach.
Estimated rates (per 100 patient-years) of ESRD and death 8.3 (95% confidence interval [CI], 7.4 to 9.2) and 5.9 (95% CI 5.2 to 6.6), respectively. Risk of ESRD and death increased progressively from stages 3 to 5. ESRD was more frequent than death in stage 4 and 5 CKD, whereas the opposite was true in stage 3 CKD. Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD, whereas older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and anemia predicted death (P < 0.05 for all). Among modifiable risk factors, proteinuria accounted for the greatest contribution to the model fit for either outcome.
In patients receiving continuity of care in Italian nephrology clinics, ESRD was a more frequent outcome than death in stage 4 and 5 CKD, but the opposite was true in stage 3. Outcomes were predicted by modifiable risk factors specific to CKD. Proteinuria used in conjunction with estimated GFR refined risk stratification. These findings provide information, specific to CKD patients under regular outpatient nephrology care, for risk stratification that complement recent observations in the general population.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory Care - statistics & numerical data</subject><subject>Analysis of Variance</subject><subject>Chi-Square Distribution</subject><subject>Continuity of Patient Care - statistics & numerical data</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Incidence</subject><subject>Italy - epidemiology</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Diseases - complications</subject><subject>Kidney Diseases - diagnosis</subject><subject>Kidney Diseases - mortality</subject><subject>Kidney Diseases - physiopathology</subject><subject>Kidney Diseases - therapy</subject><subject>Kidney Failure, Chronic - etiology</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nephrology - statistics & numerical data</subject><subject>Nonlinear Dynamics</subject><subject>Original</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Proteinuria - etiology</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkEtPwzAQhC0E4lG4cUa-wYGCdx2T5oKEwpuqIAQSN8tx7NQojYudgvrvCRQqOM1q99PsaAjZBXaECOI4vx0dMYABQ4AVsglCiH7GxMvqck5gg2zF-MpYknAU62QDYQApYLpJrh6CrxofXaTe0vzunD6o1pmmjfTRaOPeXVPR-1k7XWzpyEzHwde-mtNcBUNdQ29aVc-3yZpVdTQ7P9ojz5cXT_l1f3h_dZOfDftaoGj7WVZalSJnCVeF1dZYawtMQBeZKJWGAtICU2MxFQpS1IzzAS9L1CWelFhq3iOnC9_prJiYUneZgqrlNLiJCnPplZP_L40by8q_S85FJgR2Bvs_BsG_zUxs5cRFbepaNcbPoswYhyTlnfTI4YLUwccYjF1-ASa_qpdd9fK3-g7f-5tsCf923QEHC2DsqvGHC0bGiarrDkepX1VsTr6NEwT-CSsFjh8</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>De Nicola, Luca</creator><creator>Chiodini, Paolo</creator><creator>Zoccali, Carmine</creator><creator>Borrelli, Silvio</creator><creator>Cianciaruso, Bruno</creator><creator>Di Iorio, Biagio</creator><creator>Santoro, Domenico</creator><creator>Giancaspro, Vincenzo</creator><creator>Abaterusso, Cataldo</creator><creator>Gallo, Ciro</creator><creator>Conte, Giuseppe</creator><creator>Minutolo, Roberto</creator><general>American Society of Nephrology</general><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>20111001</creationdate><title>Prognosis of CKD Patients Receiving Outpatient Nephrology Care in Italy</title><author>De Nicola, Luca ; 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Design, setting, participants, & measurements We prospectively followed from 2003 to death or June 2010 a cohort of 1248 patients with CKD stages 3 to 5 and previous nephrology care ≥1 year in 25 Italian outpatient nephrology clinics. Cumulative incidence of ESRD or death before ESRD were estimated using the competing-risk approach.
Estimated rates (per 100 patient-years) of ESRD and death 8.3 (95% confidence interval [CI], 7.4 to 9.2) and 5.9 (95% CI 5.2 to 6.6), respectively. Risk of ESRD and death increased progressively from stages 3 to 5. ESRD was more frequent than death in stage 4 and 5 CKD, whereas the opposite was true in stage 3 CKD. Younger age, lower body mass index, proteinuria, and high phosphate predicted ESRD, whereas older age, diabetes, previous cardiovascular disease, ESRD, proteinuria, high uric acid, and anemia predicted death (P < 0.05 for all). Among modifiable risk factors, proteinuria accounted for the greatest contribution to the model fit for either outcome.
In patients receiving continuity of care in Italian nephrology clinics, ESRD was a more frequent outcome than death in stage 4 and 5 CKD, but the opposite was true in stage 3. Outcomes were predicted by modifiable risk factors specific to CKD. Proteinuria used in conjunction with estimated GFR refined risk stratification. These findings provide information, specific to CKD patients under regular outpatient nephrology care, for risk stratification that complement recent observations in the general population.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>21817127</pmid><doi>10.2215/CJN.01180211</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Ambulatory Care - statistics & numerical data Analysis of Variance Chi-Square Distribution Continuity of Patient Care - statistics & numerical data Disease Progression Female Glomerular Filtration Rate Humans Incidence Italy - epidemiology Kaplan-Meier Estimate Kidney Diseases - complications Kidney Diseases - diagnosis Kidney Diseases - mortality Kidney Diseases - physiopathology Kidney Diseases - therapy Kidney Failure, Chronic - etiology Kidney Failure, Chronic - mortality Male Middle Aged Nephrology - statistics & numerical data Nonlinear Dynamics Original Proportional Hazards Models Prospective Studies Proteinuria - etiology Risk Assessment Risk Factors Severity of Illness Index Time Factors Treatment Outcome |
| title | Prognosis of CKD Patients Receiving Outpatient Nephrology Care in Italy |
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