Outcomes of Stage 3–5 Chronic Kidney Disease before End-Stage Renal Disease at a Single Center in Taiwan

Abstract

Background: Taiwan has the highest incidence of end-stage renal disease (ESRD) in the world, but little is known about the outcomes of patients with chronic kidney disease (CKD) before ESRD in Taiwan. This study investigated the rate of renal progression and predictors for ESRD and death in a prospective cohort of patients under usual nephrologic care at a single center. Methods: A total of 433 patients at CKD stage 3–5 short of dialysis were recruited from nephrology clinics. Patients were monitored for up to 36 months or until ESRD, death or loss to follow-up. Glomerular filtration rates (GFR) were calculated by the Modification of Diet in Renal Disease abbreviated formula. Results: At baseline, mean age was 65.6 years, 61.7% were male, 33.3% were diabetic and 29.1% had cardiovascular diseases (CVD). At the end of follow-up, 123 patients (28.4%) had advanced to ESRD and 41 (9.5%) had died. Mean annual declines in GFR were 2.24, 4.22, and 3.23 ml/min/1.73 m² for stages 3, 4, and 5, respectively. By Cox regression model, patients with CVD, lower BMI and higher systolic BP were more likely to develop ESRD. Older patients with CVD and lower systolic BP were more likely to die. Conclusion: In this CKD cohort, patients were more likely to develop ESRD than cardiovascular death. The rate of GFR decline and predictors of ESRD were comparable to those reported in Western countries. Thus, the high incidence of ESRD in Taiwan may be attributed, at least in part, to lower cardiovascular mortality.

Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka

“…A similar association has been reported in a study in Taiwan [15], where 62% of the affected population was male. However, the majority of published studies have shown female-dominant CKD cohorts [4,22,23].…”

“…This demonstrated that the disease progression in our CKDu cohort was much faster than that in western countries, and we suspect that this could be a reason for the higher death rate in our cohort. The overall death rate in our cohort was 5.3% per 100 patient-years, which is higher than the rate reported in Taiwan [15]. Lack of adequate dialysis facilities to manage 17:191-198 195 the CKDu patients in this region might have contributed to this higher mortality.…”

“…Therefore, it is likely that elderly patients will die in the middle of the disease process rather than reaching the end stage of CKD. However, our CKDu cohort was relatively younger than the cohorts that have been studied in other countries [15,24,25]. Thus, we can imagine that these CKDu patients would survive until they reach endstage CKD, in contrast to the population who are already in the latter part of their life when they begin the disease process.…”

Does stage-3 chronic kidney disease matter?: A systematic literature review

“…30,32,[34][35][36][37]39,40 Two studies reported CVD morbidity 36,41 and three CVD mortality. 27,34,43 Detailed results of all-cause mortality, and CVD morbidity and mortality are given in Table 6 and Figure 2.…”

Evidence of the syndrome of rapid onset end-stage renal disease (SORO-ESRD) in the acute kidney injury (AKI) literature – preventable causes of AKI and SORO-ESRD – a call for re-engineering of nephrology practice paradigms

“…According to most nephrologists, the classic view of chronic kidney disease to end-stage renal disease (CKD-ESRD) progression is the consensus opinion of a predictable, orderly, methodical, linear, progressive, relentless and time-dependent decline in renal function, with progressively increasing serum creatinine, leading through CKD stages I, II, III, IV and V, and ultimately and inexorably ending up in ESRD and the need for renal replacement therapy (RRT) [1][2][3][4][5] ( Figure 1). Conversely, in opposition, the syndrome of rapid onset end-stage renal disease (SORO-ESRD), which we first described in 2010, is the sudden, unanticipated, precipitate and yet irreversible ESRD rapidly following AKI superimposed in a CKD patient with an a priori otherwise stable CKD [6][7][8][9][10][11][12] ( Figure 1).…”