A collaborative, individual-level analysis compared longitudinal outcomes across the International Network of Chronic Kidney Disease (iNETCKD) cohorts

Journal article

Rates of CKD progression, ESRD, all-cause mortality, and cardiovascular (CVD) events among individuals with CKD vary widely across countries. Well-characterized demographic, comorbidity, and laboratory markers captured for prospective cohorts may explain, in part, such differences. To investigate whether core characteristics of individuals with CKD explain differences in rates of outcomes, we conducted an individual-level analysis of 8 cohort studies that are part of iNET-CKD, an international network of CKD cohort studies. Overall, the rate of CKD progression was 40 events/1000 persons-year (95%CI 39 - 41), 28 (95%CI 27 - 29) for ESRD, 41 (95%CI 40 - 42) for death, and 29 (95%CI 28 - 30) for CVD events, but standardized rates were highly heterogeneous across studies (I2 >92.5%). Interactions by study group on the association between baseline characteristics and outcomes were identified. For example, the adjusted HR for CKD progression was 0.44 (95% CI 0.35 – 0.56) for women vs. men among the Japanese (CKD-JAC), while it was 0.66 (95%CI 0.59 – 0.75) among the Uruguayan (NRHP). Also, the adjusted HR for ESRD was 2.02 (95% CI 1.88 – 2.17) per 10 units lower baseline eGFR among Americans (CRIC), while it was 3.01 (95% CI 2.57 - 3.53) among Canadians (Can-PREDDICT) (interaction p-value<0.001 for comparisons across all studies). The risks of CKD progression, ESRD, death, and CVD vary across countries even after accounting for the distributions of age, sex, comorbidities, and laboratory markers. These findings support the need for a better understanding of specific factors in different populations that explain this variation.

Authors: Orlandi, P; Huang, J; Fukagawa, M; Hoy, W; Jha, V

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Kidney International
• Volume: 96
• Issue: 5
• Pages: 1217-1233
• Publication date: 2019-08-30
• Acceptance date: 2019-07-29
• DOI: 10.1016/j.kint.2019.07.024
• EISSN: 1523-1755
• ISSN: 0085-2538
• Language: English
• Keywords: international comparisons; CKD progression; epidemiology; risk factors; CKD