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Kidney Week

Abstract: PO0578

Lowering Mortality in CKD Stage 3B and CKD Stage 4 with Increased Outpatient Nephrology Visits

Session Information

Category: CKD (Non-Dialysis)

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


  • Cheung, Stephanie S., Kaiser Permanente Orange County, Anaheim, California, United States
  • Shen, Michael, Kaiser Permanente Orange County, Business Intelligence & Transformation, Santa Ana, California, United States
  • Xue, Hui, Kaiser Permanente San Diego Medical Center, San Diego, California, United States

Management of Chronic Kidney Disease(CKD) is complex requiring comprehensive evaluation of multiple organ systems. We hypothesized that more frequent outpatient nephrology visits is associated with lower mortality in advanced CKD patients.


CKD3B & CKD4 patients at Kaiser Permanente Southern California Orange County were followed from 2012 to 2018. Patients were divided into 4 groups based on initial eGFR per MDRD equation; eGFR 30-44, 25-29, 20-24, and 15-19. Each eGFR group was further divided by the number of annual nephrology visits(0, 1, 2, 3, and 4+). Patients who transitioned to dialysis, kidney transplant, or lost to follow up during the 7 years were excluded. Annual all-cause mortality was analyzed based on the number of nephrology visit in each eGFR category using ANOVA.


The cohort consisted of 2943 individuals, 59% female, 41% male, mean age 77.4. 42% of patients were diabetic and 89% had hypertension. Lower starting eGFR had increased mortality over time while renal function stayed fairly stable. Increased outpatient visit was seen with lower eGFR during the follow up period, Figure 1. All CKD3B and CKD4 patients gained a statistically significant reduction in mortality when seen at least twice in nephrology clinic annually, p<0.04, in Figure 2. For eGFR ≤24, the mortality benefit was observed with 1 or more nephrology visit, p<0.005.


CKD stage 3B and 4 patients seen in nephrology clinic at least twice a year had improved survival. More frequent follow up was associated with lower eGFR. The relationship between the lower eGFR and the improved survival warrants further investigation.


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