Competing risk of death and end-stage renal disease in incident chronic kidney disease (stages 3 to 5): the EPIRAN community-based study. Ayav, C., Beuscart, J., Briançon, S., Duhamel, A., Frimat, L., & Kessler, M. BMC nephrology, 17(1):174, November, 2016.
Competing risk of death and end-stage renal disease in incident chronic kidney disease (stages 3 to 5): the EPIRAN community-based study [link]Paper  doi  abstract   bibtex   
BACKGROUND: Although chronic kidney disease (CKD) affects a growing number of people, epidemiologic data on incident CKD in the general population are scarce. Screening strategies to increase early CKD detection have been developed. METHODS: From a community-based sample of 4,409 individuals residing in a well-defined geographical area, we determined the number of patients having a first serum creatinine value ≥1.7 mg/dL and present for at least 3 months that allowed us to calculate an annual incidence rate of CKD (stages 3 to 5). CKD (stages 3 to 5) was defined by estimated glomerular filtration rate (eGFR) \textless60 mL/min/1.73 m(2). We also described the primary care, outcomes and risk factors associated with outcomes using competing risks analyses for these CKD patients. RESULTS: A total of 631 incident CKD patients (stages 3 to 5) were followed-up until the occurrence of death and dialysis initiation for more than 3 years. The annual incidence rate of CKD (stages 3 to 5) was estimated at 977.7 per million inhabitants. Analyses were performed on 514 patients with available medical data. During the study, 155 patients (30.2 %) were referred to a nephrologist, 193 (37.5 %) died and 58 (11.3 %) reached end-stage renal disease and initiated dialysis. A total of 139 patients (27.6 %) had a fast decline of their renal function, 92 (18.3 %) a moderate decline and the 272 remaining patients had a physiological decline (21.1 %) or a small improvement of their renal function (33.0 %). Predictors of death found in both Cox and Fine-Gray multivariable regression models included age at diagnosis, anemia, active neoplasia and chronic heart failure, but not a low glomerular filtration rate (GFR). Age at diagnosis, anemia and a low GFR were independently associated with dialysis initiation in Cox model, but anemia was not found to be a risk factor for dialysis initiation in Fine-Gray model. CONCLUSIONS: This large cohort study provided useful epidemiological data on incident CKD (stages 3 to 5) and stressed the need to improve the hands-on implementation of clinical practice guidelines for the evaluation and the management of CKD in primary care.
@article{ayav_competing_2016,
	title = {Competing risk of death and end-stage renal disease in incident chronic kidney disease (stages 3 to 5): the {EPIRAN} community-based study},
	volume = {17},
	issn = {1471-2369},
	shorttitle = {Competing risk of death and end-stage renal disease in incident chronic kidney disease (stages 3 to 5)},
	url = {https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0379-3},
	doi = {10.1186/s12882-016-0379-3},
	abstract = {BACKGROUND: Although chronic kidney disease (CKD) affects a growing number of people, epidemiologic data on incident CKD in the general population are scarce. Screening strategies to increase early CKD detection have been developed.
METHODS: From a community-based sample of 4,409 individuals residing in a well-defined geographical area, we determined the number of patients having a first serum creatinine value ≥1.7 mg/dL and present for at least 3 months that allowed us to calculate an annual incidence rate of CKD (stages 3 to 5). CKD (stages 3 to 5) was defined by estimated glomerular filtration rate (eGFR) {\textless}60 mL/min/1.73 m(2). We also described the primary care, outcomes and risk factors associated with outcomes using competing risks analyses for these CKD patients.
RESULTS: A total of 631 incident CKD patients (stages 3 to 5) were followed-up until the occurrence of death and dialysis initiation for more than 3 years. The annual incidence rate of CKD (stages 3 to 5) was estimated at 977.7 per million inhabitants. Analyses were performed on 514 patients with available medical data. During the study, 155 patients (30.2 \%) were referred to a nephrologist, 193 (37.5 \%) died and 58 (11.3 \%) reached end-stage renal disease and initiated dialysis. A total of 139 patients (27.6 \%) had a fast decline of their renal function, 92 (18.3 \%) a moderate decline and the 272 remaining patients had a physiological decline (21.1 \%) or a small improvement of their renal function (33.0 \%). Predictors of death found in both Cox and Fine-Gray multivariable regression models included age at diagnosis, anemia, active neoplasia and chronic heart failure, but not a low glomerular filtration rate (GFR). Age at diagnosis, anemia and a low GFR were independently associated with dialysis initiation in Cox model, but anemia was not found to be a risk factor for dialysis initiation in Fine-Gray model.
CONCLUSIONS: This large cohort study provided useful epidemiological data on incident CKD (stages 3 to 5) and stressed the need to improve the hands-on implementation of clinical practice guidelines for the evaluation and the management of CKD in primary care.},
	language = {eng},
	number = {1},
	journal = {BMC nephrology},
	author = {Ayav, Carole and Beuscart, Jean-Baptiste and Briançon, Serge and Duhamel, Alain and Frimat, Luc and Kessler, Michèle},
	month = nov,
	year = {2016},
	pmid = {27846810},
	pmcid = {PMC5111196},
	keywords = {Competing-risk analysis, Epidemiological study, Incidence, Outcomes, Risk Factors, chronic kidney disease},
	pages = {174},
}
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