Predicting the Risk of End-stage Renal Disease in the Population-based Setting

A Retrospective Case-control Study

Eric S Johnson; David H Smith; Micah L Thorp; Xiuhai Yang; Juhaeri Juhaeri

Disclosures

BMC Nephrology. 2011;11 

In This Article

Results

Between January 2000 and December 2004, we identified 485 patients with ESRD who were treated with RRT for the first time and met all of our eligibility criteria. Ninety-six percent of the case patients had a serum creatinine measurement during the baseline period and 76% of case patients had an eGFR <60 mL/min per 1.73 m2. The rate of RRT in the cohort from which we sampled was 58 per 100,000 person-years (95% CI, 53 to 64) and the mean age was 66.4 years.

For most characteristics, control patients exhibited a higher frequency of missing data. For example, body mass index was missing for 7% of case patients, but 15% of control patients. Characteristics more closely associated with the diagnosis and management of kidney disease were missing more often for control patients: 32% of control patients lacked a serum creatinine value, but only 4% of case patients lacked a serum creatinine value; 49% of control patients lacked a urine dipstick measure of proteinuria, but only 27% of case patients lacked a urine dipstick measure of proteinuria. The odds ratios in Table 2 only reflect the crude predictive power of characteristics (after adjusting for the matching characteristics). Table 3 shows the distribution of characteristics that contributed to the multivariable model for the subgroup of patients with complete data and the subgroup that we excluded from the multivariable model because they were missing one or more characteristics. Missing serum creatinine values and urine protein values were the main reasons for exclusion.

The final multivariable model of statistically significant predictor characteristics included 350 case patients and 2,114 control patients (Table 4). We identified the following characteristics that predicted RRT: eGFR<60 mL/min per 1.73 m2 (OR = 20.5; 95% CI, 11.2 to 37.3), positive test for proteinuria (OR = 5.0; 95% CI, 3.5 to 7.1), hypertension (OR = 4.5; 95% CI, 2.5 to 8.0), gout/positive test for uric acid (OR = 2.5; 95% CI, 1.8 to 3.5), peripheral vascular disease (OR = 2.2; 95% CI, 1.4 to 3.6), congestive heart failure (OR = 2.1; 95% CI, 1.4 to 3.3), and diabetes (OR = 2.1; 95% CI, 1.5 to 2.9). We evaluated a wide range of other characteristics that did not improve the statistical prediction of ESRD beyond the characteristics shown in Table 4. Although we presented sex-specific odds ratios for the final model, we did not test for interactions by sex.

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