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Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe

(2018) KIDNEY INTERNATIONAL. 93(6). p.1432-1441
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Abstract
The incidence of renal replacement therapy varies across countries. However, little is known about the epidemiology of chronic kidney disease (CKD) outcomes. Here we describe progression and mortality risk of patients with CKD but not on renal replacement therapy at outpatient nephrology clinics across Europe using individual data from nine CKD cohorts participating in the European CKD Burden Consortium. A joint model assessed the mean change in estimated glomerular filtration rate (eGFR) and mortality risk simultaneously, thereby accounting for mortality risk when estimating eGFR decline and vice versa, while also correcting for the measurement error in eGFR. Results were adjusted for important risk factors (baseline eGFR, age, sex, albuminuria, primary renal disease, diabetes, hypertension, obesity and smoking) in 27,771 patients from five countries. The adjusted mean annual eGFR decline varied from 0.77 (95% confidence interval 0.45, 1.08) ml/min/1.73m(2) in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m(2) in the Spanish cohort. As compared to the Italian PI RP cohort, the adjusted mortality hazard ratio varied from 0.22 (0.11, 0.43) in the London LACKABO cohort to 1.30 (1.13, 1.49) in the English CRISIS cohort. These results suggest that the eGFR decline showed minor variation but mortality showed the most variation. Thus, different health care organization systems are potentially associated with differences in outcome of patients with CKD within Europe. These results can be used by policy makers to plan resources on a regional, national and European level.
Keywords
GLOMERULAR-FILTRATION-RATE, LONGITUDINAL DATA, RISK, CKD, GUIDELINES, SURVIVAL, CARE, POPULATION, EQUATION, DECLINE, ACE inhibitors, cardiovascular disease, chronic kidney disease, diabetes, obesity

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Chicago
Bruck, Katharina, Kitty J Jager, Carmine Zoccali, Aminu K Bello, Roberto Minutolo, Kyriakos Ioannou, Francis Verbeke, et al. 2018. “Different Rates of Progression and Mortality in Patients with Chronic Kidney Disease at Outpatient Nephrology Clinics Across Europe.” Kidney International 93 (6): 1432–1441.
APA
Bruck, K., Jager, K. J., Zoccali, C., Bello, A. K., Minutolo, R., Ioannou, K., Verbeke, F., et al. (2018). Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe. KIDNEY INTERNATIONAL, 93(6), 1432–1441.
Vancouver
1.
Bruck K, Jager KJ, Zoccali C, Bello AK, Minutolo R, Ioannou K, et al. Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe. KIDNEY INTERNATIONAL. 2018;93(6):1432–41.
MLA
Bruck, Katharina, Kitty J Jager, Carmine Zoccali, et al. “Different Rates of Progression and Mortality in Patients with Chronic Kidney Disease at Outpatient Nephrology Clinics Across Europe.” KIDNEY INTERNATIONAL 93.6 (2018): 1432–1441. Print.
@article{8569310,
  abstract     = {The incidence of renal replacement therapy varies across countries. However, little is known about the epidemiology of chronic kidney disease (CKD) outcomes. Here we describe progression and mortality risk of patients with CKD but not on renal replacement therapy at outpatient nephrology clinics across Europe using individual data from nine CKD cohorts participating in the European CKD Burden Consortium. A joint model assessed the mean change in estimated glomerular filtration rate (eGFR) and mortality risk simultaneously, thereby accounting for mortality risk when estimating eGFR decline and vice versa, while also correcting for the measurement error in eGFR. Results were adjusted for important risk factors (baseline eGFR, age, sex, albuminuria, primary renal disease, diabetes, hypertension, obesity and smoking) in 27,771 patients from five countries. The adjusted mean annual eGFR decline varied from 0.77 (95\% confidence interval 0.45, 1.08) ml/min/1.73m(2) in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m(2) in the Spanish cohort. As compared to the Italian PI RP cohort, the adjusted mortality hazard ratio varied from 0.22 (0.11, 0.43) in the London LACKABO cohort to 1.30 (1.13, 1.49) in the English CRISIS cohort. These results suggest that the eGFR decline showed minor variation but mortality showed the most variation. Thus, different health care organization systems are potentially associated with differences in outcome of patients with CKD within Europe. These results can be used by policy makers to plan resources on a regional, national and European level.},
  author       = {Bruck, Katharina and Jager, Kitty J and Zoccali, Carmine and Bello, Aminu K and Minutolo, Roberto and Ioannou, Kyriakos and Verbeke, Francis and Voelzke, Henry and Arnlov, Johan and Leonardis, Daniela and Ferraro, Pietro Manuel and Brenner, Hermann and Caplin, Ben and Kalra, Philip A and Wanner, Christoph and Martinez Castelao, Alberto and Gorriz, Jose Luis and Hallan, Stein and Rothenbacher, Dietrich and Gibertoni, Dino and De Nicola, Luca and Heinze, Georg and Van Biesen, Wim and Stel, Vianda S},
  issn         = {0085-2538},
  journal      = {KIDNEY INTERNATIONAL},
  keyword      = {GLOMERULAR-FILTRATION-RATE,LONGITUDINAL DATA,RISK,CKD,GUIDELINES,SURVIVAL,CARE,POPULATION,EQUATION,DECLINE,ACE inhibitors,cardiovascular disease,chronic kidney disease,diabetes,obesity},
  language     = {eng},
  number       = {6},
  pages        = {1432--1441},
  title        = {Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe},
  url          = {http://dx.doi.org/10.1016/j.kint.2018.01.008},
  volume       = {93},
  year         = {2018},
}

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