Longitudinal Follow-up and Outcomes Among a Population With Chronic Kidney Disease in a Large Managed Care Organization

Abstract

Background: Chronic kidney disease is the primary cause of end-stage renal disease inthe UnitedStates. The purpose of this study was to understand the natural his- tory of chronic kidney disease with regard to progres- sion to renal replacement therapy (transplant or dialy- sis) and death in a representative patient population. Methods: In 1996 we identified 27998 patients in our healthplanwhohadestimatedglomerularfiltrationrates of less than 90 mL/min per 1.73 m 2 on 2 separate mea- surements at least 90 days apart. We followed up pa- tients from the index date of the first glomerular filtra- tion rates of less than 90 mL/min per 1.73 m 2 until renal replacementtherapy,death,disenrollmentfromthehealth plan, or June 30, 2001. We extracted from the comput- erized medical records the prevalence of the following comorbidities at the index date and end point: hyper- tension, diabetes mellitus, coronary artery disease, con- gestive heart failure, hyperlipidemia, and renal anemia. Results: Our data showed that the rate of renal replace- ment 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 mor- tality rate was 19.5%, 24.3%, and 45.7%. Thus, death was far more common than dialysis at all stages. In addi- tion, 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.