Original investigation: pathogenesis and treatment of kidney disease and hypertension
A population-based study of the incidence and outcomes of diagnosed chronic kidney disease

https://doi.org/10.1016/S0272-6386(03)00916-8Get rights and content

Abstract

Background:

This study aims to determine the incidence rate and prognosis of detected chronic kidney disease (CKD) in a defined population.

Methods:

This is a retrospective cohort study of all new cases of CKD from Southampton and South-West Hampshire Health Authority (population base, 405,000) determined by a persistently increased serum creatinine (SCr) level (≥1.7 mg/dL [≥150 μmol/L] for 6 months) identified from chemical pathology records. Follow-up was for a mean of 5.5 years for survival, cause of death, and acceptance to renal replacement therapy (RRT).

Results:

The annual incidence rate of detected CKD was 1,701 per million population (pmp; 95% confidence interval [CI], 1,613 to 1,793) and 1,071 pmp (95% CI, 1,001 to 1,147) in those younger than 80 years. There was a steep age gradient; median age was 77 years. The man-woman rate ratio was 1.6 (95% CI, 1.4 to 1.8), with a male excess in all age groups older than 40 years. Incidence increased in areas with greater socioeconomic deprivation. Median survival was 35 months. Age, SCr level, and deprivation index were all significantly associated with survival. Standardized mortality ratios were 36-fold in those aged 16 to 49 years, 12-fold in those aged 50 to 64 years, and more than 2-fold in those older than 65 years. Cardiovascular disease (CVD) was the most common cause of death (46%). Only 4% of patients were accepted to RRT.

Conclusion:

The incidence of diagnosed CKD is common, especially in the elderly, and is greater in more deprived areas. Prognosis is poor, with CVD prominent. More research is needed to assess the effectiveness and costs of increasing referral to nephrologists of patients with CKD.

Section snippets

Methods

The study aims to ascertain all new cases of detected CKD in Southampton and South-West Hampshire (S&SWH) Health Authority (HA) presenting between July 1, 1992, and June 30, 1994. This is a mixed urban rural area with average health experience and age distribution and a less than average proportion of ethnic minorities. A case is defined as a patient with a new SCr level greater than 1.7 mg/dL (>150 μmol/L) found in this period that remained greater than this level for 6 months or more. SCr is

Incidence

There were 4,228 cases of kidney disease (SCr ≥ 1.7 mg/dL [≥150 μmol/L]) identified in residents of S&SWH HA during the study period. On the basis of SCr pattern, 1,076 cases had chronic disease, 1,324 cases had acute disease, and 1,828 had an unknown type. Forty-one cases (4%) had a persistent SCr level of 5.7 mg/dL or greater (≥504 μmol/L), and 113 cases (10%) had a persistent SCr level of 3.4 mg/dL or greater (≥301 μmol/L).

The incidence of CKD, adjusted for presumed CKD in the unknown group,

Discussion

This study provides an estimate of the incidence rate of detected (or diagnosed) CKD in routine clinical practice from a defined population; age, sex and socioeconomic determinants, and prognosis. There were rigorous efforts to ensure a complete population base and exhaustive ascertainment of cases. Findings would be generalizable to areas with predominantly Caucasian populations in the United Kingdom, given the ethnic breakdown of the local population and the setting in a southern English HA

Acknowledgements

Dr Nick Drey helped design the study; undertook data collection, analysis, and initial interpretation; and wrote the first draft of the report. Dr Mary Rogerson helped design the study, undertook data validation, and helped revise the manuscript. Dr Paul Roderick conceived the study, helped design it and interpret the results, and revised the manuscript. Mr. Mark Mullee undertook survival analyses and advised on all statistical issues. The authors thank Dr Glenn Weavind, Dr Andrew Mortimore, Dr

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