Metadatos
Mostrar el registro completo del ítemCompartir este ítem
Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy
Idioma
EN
Article de revue
Este ítem está publicado en
Kidney International Reports. 2022-11-01, vol. 7, n° 11, p. 2364-2375
Resumen en inglés
Introduction Incidence of kidney replacement therapy (KRT) varies widely across countries. Its relations to individual characteristics, nephrology practices for slowing chronic kidney disease (CKD) progression, and KRT ...Leer más >
Introduction Incidence of kidney replacement therapy (KRT) varies widely across countries. Its relations to individual characteristics, nephrology practices for slowing chronic kidney disease (CKD) progression, and KRT access remain unclear. Methods We investigated intercountry differences in kidney failure (KF) rate, defined by a sustained estimated glomerular filtration rate (eGFR) <15 ml/min per 1.73 m2, and separately in KRT incidence, before and after adjusting for risk factors and blood pressure (BP) control or renin-angiotensin-aldosterone system inhibitor (RAASi) prescription practices in the CKD Outcomes and Practice Patterns Study (CKDopps) cohort study. Results Among 7381 patients with CKD stage 3 to 4 at enrollment, 1297 progressed to KF and 947 initiated KRT over a 3-year follow-up period. Compared to the United States, demographic-adjusted and eGFR-adjusted hazard ratios (HRs) (HRs, 95% confidence intervals [CI]) for a sustained low eGFR were 0.77 (95% CI, 0.57–1.02) in Brazil, 0.90 (95% CI, 0.75–1.08) in France, and 1.03 (95% CI, 0.86–1.03) in Germany. Further adjustment for comorbidities, albuminuria, systolic BP, and RAASi prescription did not substantially change these HRs. In contrast, compared with the United States, the fully-adjusted HR for KRT remained significantly lower in Brazil (0.55, 95% CI 0.39–0.79), higher in Germany (95% CI, 1.36, 1.09–1.69), and similar in France (95% CI, 1.07, 0.81–1.39). Conclusion Individual risk factors for CKD progression in nephrology patients appeared to explain most intercountry variations in KF but not KRT incidence. This suggests a prominent role for differences in practices related to KRT initiation or access, but not those for slowing disease progression. This study also shows that using KRT as a KF surrogate may bias estimates of associations with CKD progression risk factors.< Leer menos
Palabras clave en inglés
chronic kidney disease
epidemiology
international comparisons
kidney failure
kidney replacement therapy
risk factors
Centros de investigación