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Kidney Week

Abstract: PO0534

Mortality Following New Onset of CKD Among Veterans by Comorbid Conditions: Results from a US Large Incident CKD Population

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Choudhury, Devasmita, Salem VA Medical Center, Salem, Virginia, United States
  • Yu, Wei, University of Virginia, Charlottesville, Virginia, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
  • Norris, Keith C., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Yan, Guofen, University of Virginia, Charlottesville, Virginia, United States
Background

Data on mortality rates after CKD onset are scarce. Using a recently constructed national incident CKD cohort, we examined mortality rates following new-onset CKD for various subgroups with or without comorbidities.

Methods

We identified 1,074,238 individuals with new-onset CKD between 2002 and 2017 in the US Veterans Health Administration (VHA). CKD onset was defined as the first time when estimated GFR (eGFR; CKD-EPI equation) decreased to <60 mL/min/1.73 m2 for >3 months. Individuals excluded were those in the VHA for <2 years prior to first eGFR <60, or had CKD stage 4 or 5, or end-stage kidney disease when first identified. Thus, the first time identified was close to the onset of CKD stage 3. Comorbidities at CKD onset were ascertained from ICD-9/ICD-10 codes during any time before onset and through 6 months after onset. All individuals were followed for death status from onset through June 30, 2018.

Results

CKD patients with and without comorbidities had similar mean eGFRs at onset (51 ml/min/1.73m2). Most (97%) were male and mean age at onset was 72 years. Hypertension (HTN) (90%), cardiovascular disease (CVD) (75%), and diabetes (46%) were the three most common comorbidities. For each comorbidity, mortality rate was substantially greater among those with compared to those without (Table). After adjustment for age, sex, race, ethnicity, and onset eGFR, mortality risks remained substantially greater among those with than those without the comorbidities, ranging from 12% greater with HTN to 100% greater with liver disease.

Conclusion

At time of CKD onset, mortality risk is greater in veterans with the presence of comorbidities. Intervention trials to examine the management and treatment of comorbidities on mortality in an incident CKD population might be warranted.

Mortality by comorbid conditions
ComorbidityPrevalence (%)Death rate
(per 1000 patient-years)
Adjusted hazard ratio
(95% CI)
P value
With the
comorbidity
Without the
comorbidity
HTN9075.567.51.12 (1.11-1.13)<0.001
CVD7586.446.01.75 (1.73-1.76)<0.001
Diabetes4679.970.61.33 (1.32-1.34)<0.001
Chronic obstructive
pulmonary disorder
30102.465.21.75 (1.74-1.76)<0.001
Anemia30101.865.51.60 (1.59-1.61)<0.001
Cancer25101.667.11.39 (1.38-1.40)<0.001
Gastrointestinal
bleeding disorders
1789.072.21.35 (1.34-1.36)<0.001
Liver disease597.673.82.04 (2.01-2.06)<0.001

Funding

  • NIDDK Support