Chronic kidney disease in primary care: risk of cardiovascular events, end stage kidney disease and death

BMC Primary Care

Research

Bent Lind¹  Rikke Borg²  Frederik Persson³  Margit Kriegbaum⁴  Mia Klinten Grand⁴  Christen Lykkegaard Andersen⁵ 

[1] Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark;Department of Medicine, Zealand University Hospital, Roskilde, Denmark;Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Steno Diabetes Center Copenhagen, Herlev, Denmark;The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark;

关键词: Chronic kidney disease;    Primary care;    eGFR;    Kidney function;    ESKD;   

DOI  :  10.1186/s12875-023-02077-7

 received in 2022-10-06, accepted in 2023-06-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe prevalence of chronic kidney disease (CKD) is increasing globally. Early diagnosis in primary care may have a role in ensuring proper intervention. We aimed to determine the prevalence and outcome of CKD in primary care.MethodsWe performed an observational cohort study in primary care in Copenhagen (2001–2015). Outcomes were stroke, myocardial infarction (MI), heart failure (HF), peripheral artery disease (PAD), all-cause- and cardiovascular mortality. We combined individuals with normal kidney function and CKD stage 2 as reference. We conducted cause-specific Cox proportional regressions to calculate the hazard ratios for outcomes according to CKD group. We explored the associations between kidney function and the outcomes examined using eGFR as a continuous variable modelled with penalised splines. All models were adjusted for age, gender, diabetes, hypertension, existing CVD, heart failure, LDL cholesterol and use of antihypertensive treatment.ResultsWe included 171,133 individuals with at least two eGFR measurements of which the majority (n = 157,002) had eGFR > 60 ml/min/1.73m2 at index date, and 0.05% were in CKD stage 5. Event rates were low in eGFR > 60 ml/min/1.73m2 but increased in those with higher stages of CKD. In adjusted analyses we observed an increase in hazard rates for every outcome with every increment in CKD stage. Compared to the reference group, individuals in CKD stage 4 had double the hazard rate of PAD, MI, cardiovascular and all-cause mortality.ConclusionsOur data from a large primary care cohort demonstrate an early increase in the risk of adverse outcomes already at CKD stage 3. This underlines the importance of studying early intervention in primary care.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 12