Kidney Week

Abstract: FR-PO944

Long-Term Outcomes in Persons with Stage 3 CKD Recruited from Primary Care

Session Information

• CKD Epidemiology, Risk Factors, Prevention - II
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Taal, Maarten W., University of Nottingham, Nottingham, United Kingdom

Maarten W. Taal,

• McIntyre, Natasha Juliette, Western University, London, Ontario, Canada

Natasha Juliette McIntyre,

• McIntyre, Christopher W., Western University, London, Ontario, Canada

Christopher W. McIntyre,

• Fluck, Richard James, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom

Richard James Fluck,

Background

The majority of persons with chronic kidney disease (CKD) are elderly, have moderately reduced glomerular filtration rate (GFR) and are cared for in primary care in the UK. There are few long term studies to describe the risks of adverse outcomes in this under-studied population.

Methods

Participants with CKD stage 3 were recruited from primary care in 2008-10. Clinical assessment and investigations were performed at baseline, 1 and 5 years. In 2019-20, electronic records were reviewed to obtain data on deaths and latest available outpatient estimated GFR (eGFR) and urine albumin to creatinine ratio (UACR). CKD progression was defined as a decline in eGFR of ≥25% and progression to a more advanced stage.

Results

Participants: 1741 with median (IQR) age 74 (67-79) years, eGFR 53.8 (45.3-61.7) ml/min/1.73m², UACR 0.3 (0.001-1.5) mg/mmol; 16.9% diabetes at baseline.
Outcomes: 680 deaths (39.1%); CKD progression in 430 of 1402 (30.7%) participants after a median 9.8 (9.2-10.0) years; only 24 of 1741 (1.4%) reached CKD stage 5.UACR increased from 0.3 (0.001-1.26) to 1.4 (0.3-5.90) mg/mmol (p<0.001) in 1188 participants with repeat measurements. Changes in KDIGO GFR category are presented in the table. CKD category improved in 161 (11.5%), progressed in 695 (49.6%) and did not change in 546 (38.9%). Logistic regression analysis identified male sex, diabetes status and lower baseline eGFR, higher baseline UACR and systolic blood pressure (SBP) as independent predictors of CKD progression. Cox Proportional Hazards models identified age, male sex, diabetes status, past or current smoking, lower baseline eGFR and higher baseline UACR as independent risk factors for all-cause mortality.

Conclusion

CKD progression was observed in a minority of participants and < 2% reached CKD stage 5. The risk of CKD progression was exceeded by the competing risk of death. Our observations confirm that in primary care, persons with CKD require monitoring and interventions to minimise risk of adverse outcomes but few progress to kidney failure.

Funding

• Commercial Support – Roche