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Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy

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 kidn...

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Autores principales: Alencar de Pinho, Natalia, Henn, Lisa, Raina, Rupesh, Reichel, Helmut, Lopes, Antonio A., Combe, Christian, Speyer, Elodie, Bieber, Brian, Robinson, Bruce M., Stengel, Bénédicte, Pecoits-Filho, Roberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751841/
https://www.ncbi.nlm.nih.gov/pubmed/36531894
http://dx.doi.org/10.1016/j.ekir.2022.08.018
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author Alencar de Pinho, Natalia
Henn, Lisa
Raina, Rupesh
Reichel, Helmut
Lopes, Antonio A.
Combe, Christian
Speyer, Elodie
Bieber, Brian
Robinson, Bruce M.
Stengel, Bénédicte
Pecoits-Filho, Roberto
author_facet Alencar de Pinho, Natalia
Henn, Lisa
Raina, Rupesh
Reichel, Helmut
Lopes, Antonio A.
Combe, Christian
Speyer, Elodie
Bieber, Brian
Robinson, Bruce M.
Stengel, Bénédicte
Pecoits-Filho, Roberto
author_sort Alencar de Pinho, Natalia
collection PubMed
description 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 m(2), 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.
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spelling pubmed-97518412022-12-16 Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy Alencar de Pinho, Natalia Henn, Lisa Raina, Rupesh Reichel, Helmut Lopes, Antonio A. Combe, Christian Speyer, Elodie Bieber, Brian Robinson, Bruce M. Stengel, Bénédicte Pecoits-Filho, Roberto Kidney Int Rep Clinical Research 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 m(2), 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. Elsevier 2022-09-05 /pmc/articles/PMC9751841/ /pubmed/36531894 http://dx.doi.org/10.1016/j.ekir.2022.08.018 Text en © 2022 International Society of Nephrology. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Alencar de Pinho, Natalia
Henn, Lisa
Raina, Rupesh
Reichel, Helmut
Lopes, Antonio A.
Combe, Christian
Speyer, Elodie
Bieber, Brian
Robinson, Bruce M.
Stengel, Bénédicte
Pecoits-Filho, Roberto
Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy
title Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy
title_full Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy
title_fullStr Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy
title_full_unstemmed Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy
title_short Understanding International Variations in Kidney Failure Incidence and Initiation of Replacement Therapy
title_sort understanding international variations in kidney failure incidence and initiation of replacement therapy
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751841/
https://www.ncbi.nlm.nih.gov/pubmed/36531894
http://dx.doi.org/10.1016/j.ekir.2022.08.018
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