This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (178)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Renal Diseases, Other  • Prognosis/ Outcomes  • Alert me on articles by topic

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.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Socioeconomic Disadvantage and Kidney Disease in the United States, Australia, and Thailand
White et al.
Am. J. Public Health 2008;98:1306-1313.
ABSTRACT | FULL TEXT  

Estimating Glomerular Filtration Rate in Black South Africans by Use of the Modification of Diet in Renal Disease and Cockcroft-Gault Equations
van Deventer et al.
Clin. Chem. 2008;54:1197-1202.
ABSTRACT | FULL TEXT  

Resolved: Being Fat Is Good for Dialysis Patients: The Godzilla Effect: Pro
Ikizler et al.
J. Am. Soc. Nephrol. 2008;19:1059-1064.
ABSTRACT | FULL TEXT  

Polymorphonuclear leukocyte injury by methylglyoxal and hydrogen peroxide: a possible pathological role for enhanced oxidative stress in chronic kidney disease
Nakayama et al.
Nephrol Dial Transplant 2008;0:gfn218v1-gfn218.
ABSTRACT | FULL TEXT  

Impact of subclinical carotid atherosclerosis on incident chronic kidney disease in the elderly
Chonchol et al.
Nephrol Dial Transplant 2008;0:gfn021v1-gfn021.
ABSTRACT | FULL TEXT  

Long-term Risk of Mortality and End-Stage Renal Disease Among the Elderly After Small Increases in Serum Creatinine Level During Hospitalization for Acute Myocardial Infarction
Newsome et al.
Arch Intern Med 2008;168:609-616.
ABSTRACT | FULL TEXT  

Serum Creatinine Stabilization Following Renal Artery Stenting
Bates et al.
VASC ENDOVASCULAR SURG 2008;42:40-46.
ABSTRACT  

Association of Mild to Moderate Kidney Dysfunction and Coronary Calcification
Ix et al.
J. Am. Soc. Nephrol. 2008;19:579-585.
ABSTRACT | FULL TEXT  

Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease
Toussaint et al.
Nephrol Dial Transplant 2008;23:586-593.
ABSTRACT | FULL TEXT  

The impact of population-based identification of chronic kidney disease using estimated glomerular filtration rate (eGFR) reporting
Richards et al.
Nephrol Dial Transplant 2008;23:556-561.
ABSTRACT | FULL TEXT  

Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes
Richards et al.
Nephrol Dial Transplant 2008;23:549-555.
ABSTRACT | FULL TEXT  

Survival Benefit of Nephrologic Care in Patients With Diabetes Mellitus and Chronic Kidney Disease
Tseng et al.
Arch Intern Med 2008;168:55-62.
ABSTRACT | FULL TEXT  

Renal Impairment Predicts Long-Term Mortality Risk after Acute Myocardial Infarction
Smith et al.
J. Am. Soc. Nephrol. 2008;19:141-150.
ABSTRACT | FULL TEXT  

Potential Future Uses of Calcimimetics in Patients with Chronic Kidney Disease
Chonchol and Wuthrich
NDT Plus 2008;1:i36-i41.
ABSTRACT | FULL TEXT  

Pulse wave velocity a useful tool for cardiovascular surveillance in pre-dialysis patients
Lemos et al.
Nephrol Dial Transplant 2007;22:3527-3532.
ABSTRACT | FULL TEXT  

Prevalence of Chronic Kidney Disease in the United States
Coresh et al.
JAMA 2007;298:2038-2047.
ABSTRACT | FULL TEXT  

Chronic Kidney Disease The Promise and the Perils
Couser
J. Am. Soc. Nephrol. 2007;18:2803-2805.
FULL TEXT  

Age Affects Outcomes in Chronic Kidney Disease
O'Hare et al.
J. Am. Soc. Nephrol. 2007;18:2758-2765.
ABSTRACT | FULL TEXT  

The cost of implementing UK guidelines for the management of chronic kidney disease
Klebe et al.
Nephrol Dial Transplant 2007;22:2504-2512.
ABSTRACT | FULL TEXT  

Why we should sub-divide CKD stage 3 into early (3a) and late (3b) components
Abutaleb
Nephrol Dial Transplant 2007;22:2728-2729.
FULL TEXT  

Is early chronic kidney disease an important risk factor for cardiovascular disease?: A Background Paper prepared for the UK Consensus Conference on Early Chronic Kidney Disease
Daly
Nephrol Dial Transplant 2007;22:ix19-ix25.
FULL TEXT  

Speaker Abstracts: Tuesday, 6 February 2007
Lamb et al.
Nephrol Dial Transplant 2007;22:ix45-ix53.
FULL TEXT  

Prevalence and clinical correlates of white coat hypertension in chronic kidney disease
Minutolo et al.
Nephrol Dial Transplant 2007;22:2217-2223.
ABSTRACT | FULL TEXT  

Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population--the Ohasama study
Nakayama et al.
Nephrol Dial Transplant 2007;22:1910-1915.
ABSTRACT | FULL TEXT  

Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges
Craver et al.
Nephrol Dial Transplant 2007;22:1171-1176.
ABSTRACT | FULL TEXT  

A call to action on World Kidney Day, 8 March 2007
Couser et al.
Nephrol Dial Transplant 2007;22:676-677.
FULL TEXT  

Chronic Kidney Disease: Common, Harmful, and Treatable--World Kidney Day 2007
Levey et al.
CJASN 2007;2:401-405.
FULL TEXT  

Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease
Hemmelgarn et al.
J. Am. Soc. Nephrol. 2007;18:993-999.
ABSTRACT | FULL TEXT  

Chronic Kidney Disease: Common, Harmful, and Treatable--World Kidney Day 2007
Levey et al.
J. Am. Soc. Nephrol. 2007;18:374-378.
FULL TEXT  

Association between Serum Lipids and Survival in Hemodialysis Patients and Impact of Race
Kilpatrick et al.
J. Am. Soc. Nephrol. 2007;18:293-303.
ABSTRACT | FULL TEXT  

Lipid Changes and Statins in Chronic Renal Insufficiency
Ritz and Wanner
J. Am. Soc. Nephrol. 2006;17:S226-S230.
ABSTRACT | FULL TEXT  

Role of Pulse Pressure on Cardiovascular Risk in Chronic Kidney Disease Patients
Fernandez-Fresnedo et al.
J. Am. Soc. Nephrol. 2006;17:S246-S249.
ABSTRACT | FULL TEXT  

Anemia and Cardiovascular Risk: The Lesson of the CREATE Trial
Locatelli et al.
J. Am. Soc. Nephrol. 2006;17:S262-S266.
ABSTRACT | FULL TEXT  

Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey
Hallan et al.
BMJ 2006;333:1047-1047.
ABSTRACT | FULL TEXT  

Baseline Predictors of Renal Disease Progression in the African American Study of Hypertension and Kidney Disease
Norris et al.
J. Am. Soc. Nephrol. 2006;17:2928-2936.
ABSTRACT | FULL TEXT  

The impact of traditional and non-traditional risk factors on coronary calcification in pre-dialysis patients
Tomiyama et al.
Nephrol Dial Transplant 2006;21:2464-2471.
ABSTRACT | FULL TEXT  

Decline in kidney function before and after nephrology referral and the effect on survival in moderate to advanced chronic kidney disease
Jones et al.
Nephrol Dial Transplant 2006;21:2133-2143.
ABSTRACT | FULL TEXT  

Surrogate End Points for Clinical Trials of Kidney Disease Progression
Stevens et al.
CJASN 2006;1:874-884.
FULL TEXT  

Assessing kidney function--measured and estimated glomerular filtration rate.
Stevens et al.
NEJM 2006;354:2473-2483.
FULL TEXT  

Chronic kidney disease: evolving strategies for detection and management of impaired renal function
MacGregor et al.
QJM 2006;99:365-375.
ABSTRACT | FULL TEXT  

Body Mass Index and Risk for End-Stage Renal Disease
Kalantar-Zadeh and Kopple
ANN INTERN MED 2006;144:701-701.
FULL TEXT  

Current chronic kidney disease practice patterns in the UK: a national survey
Ahmad et al.
QJM 2006;99:245-251.
ABSTRACT | FULL TEXT  

Renal Manifestations in the Metabolic Syndrome.
Locatelli et al.
J. Am. Soc. Nephrol. 2006;17:S81-S85.
ABSTRACT | FULL TEXT  

Dyslipidemia of chronic renal failure: the nature, mechanisms, and potential consequences
Vaziri
Am. J. Physiol. Renal Physiol. 2006;290:F262-F272.
ABSTRACT | FULL TEXT  

Antiatherogenic Effects of Angiotensin Receptor Antagonism in Mild Renal Dysfunction
Suganuma et al.
J. Am. Soc. Nephrol. 2006;17:433-441.
ABSTRACT | FULL TEXT  

Pressure, Waves, and Kidney Outcomes in Kidney Transplant Donors and Recipients
Toto
Hypertension 2006;47:141-142.
FULL TEXT  

Kidney-Heart Interactions: Epidemiology, Pathogenesis, and Treatment
Berl and Henrich
CJASN 2006;1:8-18.
FULL TEXT  

Coronary Heart Disease in Patients with Chronic Kidney Disease
Dennis
J. Am. Soc. Nephrol. 2005;16:S103-S106.
FULL TEXT  

A Prospective Study of Anemia Status, Hemoglobin Concentration, and Mortality in an Elderly Cohort: The Cardiovascular Health Study
Zakai et al.
Arch Intern Med 2005;165:2214-2220.
ABSTRACT | FULL TEXT  

Low Rates of Testing and Diagnostic Codes Usage in a Commercial Clinical Laboratory: Evidence for Lack of Physician Awareness of Chronic Kidney Disease
Stevens et al.
J. Am. Soc. Nephrol. 2005;16:2439-2448.
ABSTRACT | FULL TEXT  

Myeloperoxidase serves as a marker of oxidative stress during single haemodialysis session using two different biocompatible dialysis membranes
Wu et al.
Nephrol Dial Transplant 2005;20:1134-1139.
ABSTRACT | FULL TEXT  

Effects of Anemia and Left Ventricular Hypertrophy on Cardiovascular Disease in Patients with Chronic Kidney Disease
Weiner et al.
J. Am. Soc. Nephrol. 2005;16:1803-1810.
ABSTRACT | FULL TEXT  

Anemia and Diabetes in the Absence of Nephropathy
Craig et al.
Diabetes Care 2005;28:1118-1123.
ABSTRACT | FULL TEXT  

Identifying Individuals with a Reduced GFR Using Ambulatory Laboratory Database Surveillance
Garg et al.
J. Am. Soc. Nephrol. 2005;16:1433-1439.
ABSTRACT | FULL TEXT  

Survival advantages of obesity in dialysis patients
Kalantar-Zadeh et al.
Am. J. Clin. Nutr. 2005;81:543-554.
ABSTRACT | FULL TEXT  

Homocysteine in uraemia--a puzzling and conflicting story
Suliman et al.
Nephrol Dial Transplant 2005;20:16-21.
FULL TEXT