CKD Progression Risk and Subsequent Cause of Death: A Population-Based Cohort Study

Nayanjot K Rai, Zheng Wang, Paul E Drawz, John Connett, Daniel P Murphy, Nayanjot K Rai, Zheng Wang, Paul E Drawz, John Connett, Daniel P Murphy

Abstract

Rationale & objective: Chronic kidney disease (CKD) is a prevalent condition with high mortality rates. Cardiovascular disease (CVD) is accepted as the leading cause of death in CKD, but data are limited, and no study has evaluated the cause of death in those with progressive CKD versus stable kidney function.

Study design: Retrospective cohort.

Setting & participants: Adults receiving primary care at M Health Fairview (MHFV) after December 31, 2012, with linked Minnesota Death Index data before December 31, 2019, were included. A second cohort was created from adult participants in the 1996-2006 National Health and Nutrition Examination Survey (NHANES) linked with the National Death Index through 2015. Individuals with kidney replacement therapy at baseline were excluded.

Exposures: Estimated glomerular filtration rate (eGFR) and proteinuria assessed at baseline defined the exposure categories for MHFV and NHANES. CKD progression in MHFV was also defined as an eGFR decrease ≥30% from baseline or incident kidney replacement therapy.

Outcome: CVD-, malignancy-, and dementia-attributed death.

Analytical approach: Multinomial logistic regression.

Results: For both cohorts, CVD death was more common than malignancy death for those with eGFR <60 mL/min/1.73 m2, whereas the converse was true for those with higher eGFR without proteinuria. In NHANES, CVD deaths were higher in those with proteinuria and eGFR ≥60 mL/min/1.73 m2. CKD progression in MHFV had a limited impact on the association with the cause of death except on dementia deaths, which were less common with progression at several stages of CKD. Proteinuria had limited impact on the association with the cause of death across a range of eGFR levels.

Limitations: Limited follow-up and, for MHFV, nonprotocolized measures of kidney function were limitations, as were the intrinsic accuracy limitations for death certificates.

Conclusions: CVD death is the most significant cause of death observed for those with a reduced eGFR irrespective of CKD progression.

Keywords: Cardiovascular disease; cause of death; chronic kidney disease; eGFR.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Baseline period flow diagram – M Health Fairview cohort. Abbreviation: eGFR, estimated glomerular filtration rate.
Figure 2
Figure 2
Patient study-eligibility flow diagram for M Health Fairview patients.
Figure 3
Figure 3
Participant study-eligibility flow diagram for National Health and Nutrition Examination Survey (NHANES) participants.

References

    1. Murphy D., McCulloch C.E., Lin F., et al. Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016;165(7):473–481.
    1. Hill N.R., Fatoba S.T., Oke J.L., et al. Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLOS ONE. 2016;11(7)
    1. Go A.S., Chertow G.M., Fan D., McCulloch C.E., Hsu C.Y. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–1305.
    1. Navaneethan S.D., Schold J.D., Arrigain S., Jolly S.E., Nally J.V. Cause-specific deaths in non–dialysis-dependent CKD. J Am Soc Nephrol. 2015;26(10):2512–2520.
    1. Thompson S., James M., Wiebe N., et al. Cause of death in patients with reduced kidney function. J Am Soc Nephrol. 2015;26(10):2504–2511.
    1. Kerr M., Matthews B., Medcalf J.F., O’Donoghue D. End-of-life care for people with chronic kidney disease: cause of death, place of death and hospital costs. Nephrol Dial Transplant. 2017;32(9):1504–1509.
    1. Al-Wahsh H., Tangri N., Quinn R., et al. Accounting for the competing risk of death to predict kidney failure in adults with stage 4 chronic kidney disease. JAMA Netw Open. 2021;4(5)
    1. Liu P., Quinn R.R., Lam N.N., et al. Progression and regression of chronic kidney disease by age among adults in a population-based cohort in Alberta, Canada. JAMA Netw Open. 2021;4(6)
    1. Sud M., Tangri N., Pintilie M., Levey A.S., Naimark D.M. Progression to stage 4 chronic kidney disease and death, acute kidney injury and hospitalization risk: a retrospective cohort study. Nephrol Dial Transplant. 2016;31(7):1122–1130.
    1. National Health and Nutrition Examination Survey Analytic Guidelines, 2011-2014 and 2015-2016. December 14, 2018.
    1. National Center for Health Statistics 2015 Public-Use Linked Mortality Files.
    1. Inker L.A., Eneanya N.D., Coresh J., et al. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385(19):1737–1749.
    1. Eknoyan G., Lameire N., Eckardt K., et al. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013;3(1):5–14.
    1. Coresh J., Turin T.C., Matsushita K., et al. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. JAMA. 2014;311(24):2518–2531.
    1. Tonelli M., Muntner P., Lloyd A., et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet. 2012;380(9844):807–814.
    1. Gansevoort R.T., Correa-Rotter R., Hemmelgarn B.R., et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013;382(9889):339–352.
    1. Hartmann A., Jenssen T., Holdaas H. Diabetes, chronic kidney disease and cancer risk. Nephrol Dial Transplant. 2012;27(8):3018–3020.
    1. Malyszko J., Tesarova P., Capasso G., Capasso A. The link between kidney disease and cancer: complications and treatment. Lancet. 2020;396(10246):277–287.
    1. Ishii T., Fujimaru T., Nakano E., et al. Association between chronic kidney disease and mortality in stage IV cancer. Int J Clin Oncol. 2020;25(9):1587–1595.
    1. Drew D.A., Weiner D.E., Sarnak M.J. Cognitive impairment in CKD: pathophysiology, management, and prevention. Am J Kidney Dis. 2019;74(6):782–790.
    1. Gabin J.M., Romundstad S., Saltvedt I., Holmen J. Moderately increased albuminuria, chronic kidney disease and incident dementia: the HUNT study. BMC Nephrol. 2019;20(1):261.
    1. Zhang C.Y., He F.F., Su H., Zhang C., Meng X.F. Association between chronic kidney disease and Alzheimer’s disease: an update. Metab Brain Dis. 2020;35(6):883–894.
    1. National Center for Health Statistics Leading Causes of Death.
    1. National Center for Health Statistics Instructions for Classification of Underlying and Multiple Causes of Death - 2021.
    1. National Center for Health Statistics Instructions for Classification of Underlying and Multiple Causes of Death - 2021.
    1. Dew D. SAGE Publications; 2008. Construct. Encyclopedia of Survey Research Methods; pp. 134–135.
    1. Navarra S., Solini A., Baroni M.G., Frova L., Grande E. A long-term nationwide study on chronic kidney disease-related mortality in Italy: trends and associated comorbidity. J Nephrol. 2022;35(2):505–515.
    1. Cambridge B., Cina S.J. The accuracy of death certificate completion in a suburban community. Am J Forensic Med Pathol. 2010;31(3):232–235.
    1. Redelings M.D., Sorvillo F., Simon P. A comparison of underlying cause and multiple causes of death: US vital statistics, 2000-2001. Epidemiology. 2006;17(1):100–103.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi