NDT Advance Access published online on July 12, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm396
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Elevated relative mortality risk with mild-to-moderate chronic kidney disease decreases with age
1Health Sciences Research Institute and 2Clinical Sciences Research Institute, Warwick Medical School, University Of Warwick, Coventry, CV4 7AL, 3Clinical Biochemistry, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX and 4Department of Nephrology, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
Correspondence and offprint requests to: Dr Robert M. Higgins, MD, Consultant Nephrologist, Department of Nephrology, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK. Email: robert.higgins{at}uhcw.nhs.uk
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Abstract |
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Background. Renal disease is common in the general population and whilst few people progress to end-stage renal failure, mortality is increased. The aim of this study was to examine all-cause mortality risk in relation to chronic kidney disease (CKD) stages defined by estimated glomerular filtration rate (eGFR).
Methods. Data were extracted from a computerized central laboratory system for a defined geographical area over a 3-year study period. The eGFR was calculated using the four-variable Modification of Diet in Renal Disease (MDRD) formula and aligned to the MDRD laboratory. Average annual mortality and relative risk (RR) of all-cause mortality was determined and compared for defined age and CKD bands.
Results. 106 366 participants (55.5% female; 85% White, 13% South Asian, 2% Black and others) were eligible and studied, representing 49% of the Coventry adult population. 12 540 (12%) of the sample had some evidence of decreased kidney function, with an eGFR <60 ml/min/1.73 m2. 7611 (7%) participants died and there were significantly elevated risks of mortality with increasing renal dysfunction; RR = 4.0, 8.3, 16.2 and 43.5 for eGFR 45–59, 30–44, 15–29 and <15 ml/min/1.73 m2, respectively. Within age bands, RRs were statistically significantly raised with CKD progression and within CKD stage, RR of death decreased as age increased.
Conclusions. CKD prevalence increased with age and absolute and RR of mortality increased with progression of CKD. People aged over 75 years, with mild-to-moderate renal disease, representing 41% of this age group, have no increased RR of mortality. Further study of CKD and mortality, particularly progression over time and with respect to age is needed.
Keywords: all-cause mortality; chronic kidney disease; diabetes; South Asian ethnicity
The authors wish it to be known that, in their opinion the first two authors contributed equally to this work.
Received for publication: 2. 1.07
Accepted in revised form: 29. 5.07
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