Chronic Kidney Disease in Primary Care: Outcomes after Five Years in a Prospective Cohort Study.

摘要: Background Chronic kidney disease (CKD) is commonly managed in primary care, but most guidelines have a secondary care perspective emphasizing the risk of end-stage (ESKD) and need for renal replacement therapy. In this prospective cohort study, we sought to study detail natural history CKD better inform appropriate emphasis future guidance. Methods Findings In 1,741 people with stage 3 were individually recruited from 32 practices Derbyshire, United Kingdom. Study visits undertaken at baseline, year 1, 5. Binomial logistic regression Cox proportional hazards models used model progression, remission, all-cause mortality. We Kidney Disease: Improving Global Outcomes (KDIGO) criteria define progression defined remission as absence diagnostic (estimated glomerular filtration rate [eGFR] >60 ml/min/1.73 m2 urine albumin-to-creatinine ratio [uACR] <3 mg/mmol) any visit. Participants predominantly elderly (mean ± standard deviation (SD) age 72.9 9.0 y), relatively mild reduction GFR SD eGFR 53.5 11.8 mL/min/1,73 m2) low prevalence albuminuria (16.9%). After 5 y, 247 participants (14.2%) had died, cardiovascular causes. Only 4 (0.2%) developed ESKD, 308 (17.7%) evidenced by KDIGO criteria. Stable was observed 593 (34.1%), 336 (19.3%) met remission. Remission baseline 1 associated high likelihood (odds [OR] = 23.6, 95% CI 16.5–33.9 relative no visits). Multivariable analyses confirmed key factors predicting adverse well positive outcomes. Limitations include reliance on estimated using Modification Diet Renal Disease (MDRD) equation recruitment (but not subsequent analysis) population that white, implying results may be directly applicable younger populations more diverse ethnicity. Conclusions Management should focus principally identifying minority outcomes, allow intervention slow reduce events. Efforts also made identify reassure majority who are ESKD. Consideration given adopting an age-calibrated definition avoid labelling large group age-related decline having CKD.