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Validation of chronic kidney disease risk categorization system in C hinese patients with kidney disease: A cohort study
Author(s) -
Liu Qingyan,
Lv Jicheng,
Li Haixia,
Jiao Lili,
Yang Hongyun,
Song Yinan,
Xu Guobin
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12528
Subject(s) - medicine , proteinuria , renal function , hazard ratio , kidney disease , cohort , cohort study , confidence interval , kidney
Aim To validate the K idney D isease: I mproving G lobal O utcomes ( KDIGO ) guidelines risk stratification system based on the combination of estimated glomerular filtration rate ( eGFR) and proteinuria. Methods This was a cohort study. A total of 1219 study population were recruited. Estimated GFR and proteinuria measured by using 24 h urine protein excretion rate ( PER ) were predictors. Adverse outcomes included all‐cause mortality ( ACM ) and end‐stage renal disease ( ESRD ). Follow‐up was done by regular visit, telephone interview and electronic medical records. Results Over a median follow‐up of 4.6 years, 153 (12.6%) and 43 (3.5%) patients experienced ESRD and ACM , respectively. On multivariable analysis, the adjusted hazard ratio for ESRD and ACM (compared with patients with eGFR > 60 mL/min per 1.73 m 2 ) was of 29.8 and 3.6 for those with eGFR of 15–29 mL/min per 1.73 m 2 , respectively. The adjusted hazard ratio for ESRD and ACM (compared with patients with PER < 150 mg/24h) was of 15.9 and 3.9 for those with PER > 500 mg/24h. Higher KDIGO guidelines risk categories (indicating lower eGFR or higher proteinuria) were associated with a graded increase in the risk for the ESRD ( P < 0.001) and ACM ( P < 0.001). Reclassification of KDIGO guidelines risk categories yielded net reclassification improvements for those with ESRD or ACM event ( NRI events ) of 33.3% or 30.2%. Conclusion Lower eGFR and higher proteinuria are risk factors for ESRD and ACM in Chinese patients. The KDIGO guidelines risk categorization system assigned patients who went on to have the event to more appropriate CKD risk categories.