Show simple item record

dc.contributor.authorShardlow, Adam
dc.contributor.authorMcIntyre, Natasha
dc.contributor.authorFluck, Richard
dc.contributor.authorMcIntyre, Christopher
dc.contributor.authorTaal, Maarten
dc.date.accessioned2016-09-27T13:58:38Z
dc.date.available2016-09-27T13:58:38Z
dc.date.issued2016-09
dc.identifier.citationPLoS Med. 2016 Sep 20;13(9):e1002128. doi: 10.1371/journal.pmed.1002128. eCollection 2016.language
dc.identifier.urihttp://hdl.handle.net/20.500.12904/745
dc.description.abstractBACKGROUND: Chronic kidney disease (CKD) is commonly managed in primary care, but most guidelines have a secondary care perspective emphasizing the risk of end-stage kidney disease (ESKD) and need for renal replacement therapy. In this prospective cohort study, we sought to study in detail the natural history of CKD in primary care to better inform the appropriate emphasis for future guidance. METHODS AND FINDINGS: In this study, 1,741 people with CKD stage 3 were individually recruited from 32 primary care practices in Derbyshire, United Kingdom. Study visits were undertaken at baseline, year 1, and year 5. Binomial logistic regression and Cox proportional hazards models were used to model progression, CKD remission, and all-cause mortality. We used Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define CKD progression and defined CKD remission as the absence of diagnostic criteria (estimated glomerular filtration rate [eGFR] >60 ml/min/1.73 m2 and urine albumin-to-creatinine ratio [uACR] <3 mg/mmol) at any study visit. Participants were predominantly elderly (mean ± standard deviation (SD) age 72.9 ± 9.0 y), with relatively mild reduction in GFR (mean ± SD eGFR 53.5 ± 11.8 mL/min/1,73 m2) and a low prevalence of albuminuria (16.9%). After 5 y, 247 participants (14.2%) had died, most of cardiovascular causes. Only 4 (0.2%) developed ESKD, but 308 (17.7%) evidenced CKD progression by KDIGO criteria. Stable CKD was observed in 593 participants (34.1%), and 336 (19.3%) met the criteria for remission. Remission at baseline and year 1 was associated with a high likelihood of remission at year 5 (odds ratio [OR] = 23.6, 95% CI 16.5-33.9 relative to participants with no remission at baseline and year 1 study visits). Multivariable analyses confirmed eGFR and albuminuria as key risk factors for predicting adverse as well as positive outcomes. Limitations of this study include reliance on GFR estimated using the Modification of Diet in Renal Disease study (MDRD) equation for recruitment (but not subsequent analysis) and a study population that was predominantly elderly and white, implying that the results may not be directly applicable to younger populations of more diverse ethnicity. CONCLUSIONS: Management of CKD in primary care should focus principally on identifying the minority of people at high risk of adverse outcomes, to allow intervention to slow CKD progression and reduce cardiovascular events. Efforts should also be made to identify and reassure the majority who are at low risk of progression to ESKD. Consideration should be given to adopting an age-calibrated definition of CKD to avoid labelling a large group of people with age-related decline in GFR and low associated risk as having CKD.language
dc.language.isoenlanguage
dc.subjectChronic Kidney Diseaselanguage
dc.subjectPrimary Carelanguage
dc.subjectEpidemiologylanguage
dc.titleChronic Kidney Disease in Primary Care: Outcomes after Five Years in a Prospective Cohort Study.language
dc.typeArticlelanguage
refterms.dateFOA2021-06-03T10:09:37Z


Files in this item

Thumbnail
Name:
(201) PLoS One.PDF
Size:
425.4Kb
Format:
PDF

This item appears in the following Collection(s)

Show simple item record