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Abstract: PO2350

International Variation in the Incidence of Kidney Failure in the CKD Outcomes and Practice Patterns Study (CKDopps)

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Alencar de Pinho, Natalia, Paris-Saclay University, UVSQ, Inserm, Center for Research in Epidemiology and Population Health, Villejuif, France
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Muenz, Daniel G., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Lopes, Antonio Alberto, Universidade Federal da Bahia, Salvador, BA, Brazil
  • Reichel, Helmut, Nephrological center, Villingen-Schwenningen, Germany
  • Combe, Christian, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Stengel, Benedicte, Paris-Saclay University, UVSQ, Inserm, Center for Research in Epidemiology and Population Health, Villejuif, France
Background

Data from kidney replacement therapy (KRT) registries suggest large international variation in the incidence of kidney failure (KF). However, these data strongly depend on treatment availability and practices of KRT initiation. Measuring the incidence of sustained low eGFR, i.e. <15 mL/min/1.73 m2, would enable to explore differences in progression to KF across countries after adjusting for individual characteristics.

Methods

We analyzed data from patients with CKD stages G3-G4, under nephrology care in representative samples of clinics in Brazil (n= 747), France (n= 2786), Germany (n= 2539), and the United States (n=1309), participating in the CKDopps. We used Weibull PH models to compare the risk of KRT initiation across countries, and Illness-death models for interval censored data, to compare the risk of sustained low eGFR and to estimate probabilities of KF (composite of KRT initiation and sustained low eGFR).

Results

Median age (years) ranged from 67 in Brazil to 75 in Germany, mean baseline eGFR (ml/min/1.73m2) from 27 in Germany to 33 in France; male sex from 52% in the United States to 66% in France. After a median follow-up of 4.0 (2.6-5.0) years, 1648 patients met a sustained low eGFR, and 1343 initiated KRT. Compared with the United States, the adjusted hazard ratios indicated 44%- lower risk of KRT initiation in Brazil (95%CI 0.39 to 0.79), similar risk in France (1.05, 95%CI 0.83 to 1.33), and 41%- higher risk in Germany (95% CI 1.12 to 1.77). The same pattern was observed for sustained low eGFR, but differences were narrowed. Two-year cumulative probability of KF ranged from 13% in Brazil to 16% in Germany (Figure).

Conclusion

The incidence of KF varies across CKDopps countries, but to a much lesser extent than the incidence of KRT initiation. This finding highlights the relevance of such approach to disentangle the effects on CKD progression from those on access to care.

Funding

  • Commercial Support –