Abstract: FR-PO498

Survival of Patients with CKD Stage 3-5 in Iceland

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Jonsson, Arnar Jan, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Lund, Sigrun Helga, University of Iceland, Reykjavík, Iceland
  • Palsson, Runolfur, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
  • Indridason, Olafur S., Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
Background

The purpose of this study was to estimate hazard ratio (HR) for death in patients with chronic kidney disease (CKD) stage 3-5 and to estimate the survival benefit of renal replacement therapy in CKD stage 5.

Methods

We obtained all SCr values from all clinical laboratories in Iceland for the years, 2008-2013. Data on age, gender, diagnoses of comorbid conditions (ICD-9 and ICD-10 codes) and HbA1c measurements were retrieved from electronic medical records. Information on initiation of renal replacement therapy was also obtained. The CKD-EPI equation was used to calculate eGFR. CKD was defined and staged according to the KDIGO classification system. Computerized algorithms were used to identify and exclude episodes of acute kidney injury. For CKD stage survival analysis, Cox regression model, using age as time scale was used to calculate hazard ratios adjusted for age, sex, hypertension, diabetes, coronary artery disease and acute kidney injury. For hazard ratio calculations for stage 5 with RRT compared to no RRT we used cox regression model with time on study, adjusted for age as continuous variable, sex, hypertension, diabetes and coronary artery disease.

Results

We retrieved 1,230,563 SCr values for 183,931 individuals aged 18 years and older. The median age was 62 years (range: 18 – 108) and 47.5% were men. A total of 13152 (7.2%) patients had CKD, 8951 (4.9%), 3252 (1.8%), 798 (0.4%) and 151 (0.08%) in stage 3A, 3B, 4 and 5, respectively and 234 patients received RRT. Compared to individuals without CKD, the adjusted hazard ratio for death for CKD stage 3a, 3b, 4 and 5 were 0.94 (95%CI: 0.88 – 1.00), 1.15 (95%CI: 1.05 - 1.26), 1.84(1.59 – 2.14) and 3.08(2.31 – 4.09) respectively in men and 0.85 (95%CI: 0.80 – 0.91), 0.98 (95%CI: 0.90 - 1.07), 1.60(1.38 – 1.85) and 4.48(3.18 – 6.30) in women, respectively. For individuals with stage 5 and receiving RRT the HR for death was: 0.43 (95%CI: 0.27 – 0.68) compared to those that did not receive RRT. For individuals aged 65-74 the HR was 0.80 (95%CI: 0.33 – 1.92) and for individuals aged 75 or older the HR was: 0.32 (95%CI: 0.17 – 0.57).

Conclusion

This nationwide study, comprising the majority of the Icelandic populations does not confirm increased risk of death with stage 3a and 3b as previously reported. Renal replacement therapy seems to improve survival for patients with CKD stage 5, particularly for the aged

Funding

  • Government Support - Non-U.S.