Longitudinal Follow-up and Outcomes Among a Population With Chronic Kidney Disease in a Large Managed Care Organization

TLDR

Chronic kidney disease is the leading cause of end‑stage renal disease in the United States. This study aimed to characterize the natural history of CKD by examining progression to renal replacement therapy or death in a representative managed‑care population. Researchers identified 27,998 plan members in 1996 with two eGFR measurements <90 mL/min/1.73 m² at least 90 days apart and followed them through RRT, death, disenrollment, or June 30 2001, extracting comorbidity prevalence from electronic records. During five years, RRT rates were 1.1 %, 1.3 %, and 19.9 % for K/DOQI stages 2, 3, 4, while mortality rates were 19.5 %, 24.3 %, and 45.7 %, making death far more common than dialysis, with higher prevalence of CHF, CAD, diabetes, and anemia among those who died.

Abstract

<h3>Background</h3> Chronic kidney disease is the primary cause of end-stage renal disease in the United States. The purpose of this study was to understand the natural history of chronic kidney disease with regard to progression to renal replacement therapy (transplant or dialysis) and death in a representative patient population. <h3>Methods</h3> In 1996 we identified 27 998 patients in our health plan who had estimated glomerular filtration rates of less than 90 mL/min per 1.73 m²on 2 separate measurements at least 90 days apart. We followed up patients from the index date of the first glomerular filtration rates of less than 90 mL/min per 1.73 m²until renal replacement therapy, death, disenrollment from the health plan, or June 30, 2001. We extracted from the computerized medical records the prevalence of the following comorbidities at the index date and end point: hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, hyperlipidemia, and renal anemia. <h3>Results</h3> Our data showed that the rate of renal replacement therapy over the 5-year observation period was 1.1%, 1.3%, and 19.9%, respectively, for the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) stages 2, 3, and 4, but that the mortality rate was 19.5%, 24.3%, and 45.7%. Thus, death was far more common than dialysis at all stages. In addition, congestive heart failure, coronary artery disease, diabetes, and anemia were more prevalent in the patients who died but hypertension prevalence was similar across all stages. <h3>Conclusion</h3> Our data suggest that efforts to reduce mortality in this population should be focused on treatment and prevention of coronary artery disease, congestive heart failure, diabetes mellitus, and anemia.