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Nephrol Dial Transplant. 2012 Jun;27(6):2297-303. doi: 10.1093/ndt/gfr659. Epub 2011 Nov 18.

The evolution of renal function and the incidence of end-stage renal disease in patients aged ≥ 50 years.

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  • 1Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium.



The prevalence of chronic kidney disease (CKD) is high, especially among older patients.


In order to identify risk factors for the evolution towards end-stage renal disease (ESRD), a cohort of patients ≥ 50 years of age for whom at least four serum creatinine measurements were available were selected from a primary care-based database. The slope of changes in estimated glomerular filtration rate (eGFR) (using the Modification of Diet in Renal Disease formula) was calculated, and ESRD was defined as eGFR <15 mL/min. Risk factors for ESRD were analysed using Cox regression analysis.


The cohort included 24,682 patients (13,305 women) with a mean age at first available measurement of 64 years. During follow-up (average 7.8 years), 212 patients (0.9%) developed ESRD. The incidence of ESRD per 10,000 person-years is low and depends on baseline eGFR (Stages 0-2: 3, Stage 3A: 13, Stage 3B: 121 and Stage 4: 765). Adjusted hazard ratios (HRs) for patients with baseline eGFR in Stage 3B or 4 depended on age (HR = 0.47 or 0.41 for patients 65-79 years and HR = 0.26 or 0.32 for patients ≥ 80 years compared with patients aged 50-64 years). Females (HR = 1.48) and patients with diabetes (HR = 1.20), hypertension (HR = 1.25), high total cholesterol (HR = 1.28) or high low-density lipoprotein (LDL) cholesterol (HR = 1.39) were at higher risk for ESRD.


Baseline eGFR, diabetes, high cholesterol, high LDL, hypertension and female gender are independent risk factors for developing ESRD. Older age at baseline predicts a lower risk.

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