Abstract: TH-PO417
Incidences of ESKD and Death Before ESKD Among US Veterans with New-Onset CKD
Session Information
- CKD: Risk Scores and Translational Epidemiology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Yan, Guofen, University of Virginia, Charlottesville, Virginia, United States
- Greene, Tom, University of Utah, Salt Lake City, Utah, United States
- Nee, Robert, Walter Reed National Military Medical Center, Vienna, Virginia, United States
- Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
- Oliver, Mohammed Norman, Virginia Department of Health, Richmond, Virginia, United States
- Yu, Wei, University of Virginia, Charlottesville, Virginia, United States
- Norris, Keith C., UCLA, Marina Del Rey, California, United States
Background
Epidemiologic data on competing-risk events of progressing to ESKD or dying before ESKD are mixed due to prevalent cohorts used. Using a recently constructed national incident CKD cohort, we report the 5-year incidence of these two events following new CKD onset by demographics, kidney function and comorbid conditions.
Methods
The cohort included 534,972 subjects with new onset CKD (stage 3-5) between 2002 and 2011 in the U.S. Veteran Affairs database. CKD onset was determined by two eGFRs (based on CKD-EPI equation) <60 mL/min/1.73 m2 at >90 days apart. We excluded subjects in the database who had <2 years before the first eGFR<60 or had prior ESKD. As such, the index date identified was very close to new onset CKD. All subjects were followed for 5 years.
Results
The three groups had similar mean eGFRs at onset (range 49-50 ml/min/1.73m2) and gender distributions (97-98% male). Blacks had younger onset age (mean 67 yrs) than Hispanics (71 yrs) and whites (74 yrs). Over the course of 5 years after onset, approximately two-thirds of the initial cohort remained alive in pre-ESKD, with Blacks having a lower percentage (65%) than Hispanics and Whites (68%). Among the one-third who progressed, Blacks and Hispanics had greater percentages who progressed to ESKD than Whites (10%, 7%, and 2%, respectively), whereas they had smaller percentages of dying before ESKD (25%) than Whites (30%). Males were more likely than females to develop these two events. The relative likelihood of the two events also varied by age and eGFR stage (Table), as well as comorbidities such as diabetic and hypertensive status and cardiovascular diseases (not shown).
Conclusion
Improving outcomes for patients with CKD could be more effective by identifying risk factors associated with differential risks of developing ESKD and dying before ESKD.
Percentages of events within 5 years of CKD onset
| Black (n=56,949) | Hispanic (n=17,414) | White (n=460,609) | |||||||
| Group | Alive in pre-ESKD | ESKD | Death before ESKD | Alive in pre-ESKD | ESKD | Death before ESKD | Alive in pre-ESKD | ESKD | Death before ESKD |
| Overall | 65.1 | 10.2 | 24.7 | 67.7 | 6.7 | 25.6 | 68.1 | 2.3 | 29.6 |
| Male | 64.8 | 10.2 | 25.0 | 67.5 | 6.8 | 25.8 | 67.9 | 2.3 | 29.8 |
| Female | 77.9 | 9.3 | 12.8 | 81.5 | 4.4 | 14.0 | 77.5 | 1.2 | 21.3 |
| Age 18-55 | 61.9 | 25.0 | 13.1 | 62.5 | 23.7 | 13.8 | 75.1 | 9.3 | 15.6 |
| Age 56-75 | 70.3 | 9.3 | 20.4 | 73.2 | 7.4 | 19.4 | 75.9 | 3.0 | 21.1 |
| Age >75 | 55.1 | 2.4 | 42.5 | 60.4 | 1.7 | 37.9 | 60.2 | 1.1 | 38.7 |
| eGFR 30-59 | 68.0 | 7.4 | 24.6 | 69.9 | 4.8 | 25.3 | 69.4 | 1.5 | 29.1 |
| eGFR <30 | 23.8 | 51.1 | 25.1 | 28.9 | 40.4 | 30.7 | 34.9 | 22.1 | 43.1 |
Funding
- NIDDK Support