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Titolo Longitudinal Follow-up and Outcomes Among
Autore Douglas S. Keith, MD; Gregory A. Nichols, MBA, PhD; Christina M. Gullion, PhD;
Referenza Arch Intern Med. 2004;164:659-663
Contenuto Chronic kidney disease is the primary cause of end-stage renal disease in the United States. The purpose of this study was to understand the natural history of chronic kidney disease with regard to progression to renal replacement therapy (transplant or dialysis) and death in a representative patient population. In 1996 27998 patients were identified , who had estimated glomerular filtration rates of less than 90 mL/min per 1.73 m2 on 2 separate measurements at least 90 days apart. The patients were followed up from the index date of the first glomerular filtration rates of less than 90 mL/min per 1.73 m2 until renal replacement therapy, death, disenrollment from the health plan, or June 30, 2001. From the computerized medical records the prevalence were extracted of the following comorbidities at the index date and end point: hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, hyperlipidemia, and renal anemia. The data showed that the rate of renal replacement therapy over the 5-year observation period was 1.1%, 1.3%, and 19.9%, respectively, for the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) stages 2, 3, and 4, but that the mortality rate was 19.5%, 24.3%, and 45.7%. Thus, death was far more common than dialysis at all stages. In addition, congestive heart failure, coronary artery disease, diabetes, and anemia were more prevalent in the patients who died but hypertension prevalence was similar across all stages. Conclusion: efforts to reduce mortality in this population should be focused on treatment and prevention of coronary artery disease, congestive heart failure, diabetes mellitus, and anemia.
Data 27.06.2004
 
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