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Douglas S. Keith, MD; Gregory A. Nichols, MBA, PhD; Christina M. Gullion, PhD; Jonathan Betz Brown, MPP, PhD; David H. Smith, RPh, PhD

Arch Intern Med. 2004;164:659-663.

Background  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.

Methods  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 m² on 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 m² until 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.

Results  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.

Conclusion  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.

From the Division of Nephrology and Hypertension, Oregon Health and Science University (Dr Keith), the Kaiser Permanente Center for Health Research (Drs Nichols, Gullion, Brown, and Smith), and the University of Washington School of Pharmacy (Dr Smith). Dr Keith is now with McGill University. The authors have no relevant financial interest in this article.

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