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15-year-change of phenotype and prognosis in non-dialysis CKD patients referred to a nephrology clinic

  • Nephrology - Original Paper
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Abstract

Purpose

Changes over time of phenotype and prognosis in CKD patients starting nephrology care are undefined. This information is critical to correctly plan and optimize healthcare resources and clinical management in tertiary care.

Methods

We performed a long-term observational cohort study including 2,866 non-dialysis CKD patients newly referred to our nephrology clinic from 2004 to 2018. Three cohorts were constituted based on 5-year calendar intervals (2004–2008, 2009–2013, and 2014–2018). The changes over time of main demographic, clinical and laboratory characteristics were compared among the three cohorts. We also compared between cohorts the risk of renal death (combined endpoint of renal replacement therapy-RRT, or death before RRT) as well as of the single components (RRT or death).

Results

Across the three cohorts, we detected a significant increase in the prevalence of age ≥ 75 years (from 22.0 to 28.4%), male gender (from 53.1 to 62.1%), diabetes (from 32.6 to 39.5%), severe proteinuria ≥ 500 mg/24 h (from 46.9 to 52.4%). Mean eGFR at referral declined from 56.8 ± 27.0 to 49.6 ± 26.1 mL/min/1.73m2. Incidence of renal death significantly declined over time (5.36, 3.22 and 4.54/100 pts-year in 2004–2008, 2009–2013 and 2014–2018 cohorts, respectively). As compared with patients referred in 2004–2008, adjusted risk of renal death was lower in patients referred in 2009–2013 (HR 0.49, 95%CI 0.34–0.69) and 2014–2018 (HR 0.61, 95%CI 0.45–0.84). Similar results were obtained for RRT, while mortality did not change over time.

Conclusions

In the last 15 years, phenotype of newly referred CKD patients has remarkably changed with increasing frequency of older patients and more severe disease; however, renal survival improved suggesting greater efficacy of nephrology care.

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Availability of data and materials

Original data are available by request to corresponding author.

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Funding

This research did not receive any grant, funds, fees and support.

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Author notes

  1. Carlo Garofalo, Silvio Borrelli and Toni De Stefano have equally contributed to the paper.

Authors and Affiliations

  1. Division of Nephrology, Department of Scienze Mediche e Chirurgiche Avanzate, University of Campania “Luigi Vanvitelli”, Via M. Longo 50, 80138, Naples, Italy

    Carlo Garofalo, Silvio Borrelli, Toni De Stefano, Luca De Nicola, Carlo Vita, Nicola Peruzzu, Antonella Netti, Giuseppe Conte & Roberto Minutolo

  2. Division of Nephrology, Department of Health Sciences, “Magna Graecia” University, Catanzaro, Italy

    Michele Provenzano

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  1. Carlo Garofalo
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Contributions

Research idea and study design: CG and RM. Data acquisition: SB, CG, CV, TDS, NP, AN, MP, and RM. Data analysis/interpretation: RM, TDS, CG, SB, CV, RM, and GC. Statistical analysis: SB, CG, TDS, MP, and RM. Providing intellectual content of critical importance to the work described: RM, LDN, CG, and GC. Final approval of the version to be published: all authors.

Corresponding author

Correspondence to Carlo Garofalo.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board and patients gave written consent to use their clinical data.

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Garofalo, C., Borrelli, S., De Stefano, T. et al. 15-year-change of phenotype and prognosis in non-dialysis CKD patients referred to a nephrology clinic. Int Urol Nephrol 54, 679–686 (2022). https://doi.org/10.1007/s11255-021-02944-1

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  • DOI: https://doi.org/10.1007/s11255-021-02944-1

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