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Am J Kidney Dis. 2014 Jun;63(6):928-36. doi: 10.1053/j.ajkd.2013.12.008. Epub 2014 Jan 28.

CKD stage at nephrology referral and factors influencing the risks of ESRD and death.

Author information

  • 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • 2Division of Nephrology, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
  • 3Division of Nephrology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
  • 4Department of Biostatistics, University Health Network, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • 5Division of Nephrology, Tufts Medical Center, Boston, MA.
  • 6Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address:



Patients with chronic kidney disease (CKD) stages 3-5 are at increased risk of progressing to end-stage renal disease (ESRD) or dying prior to the development of ESRD compared with patients with less severe CKD. The magnitude of these risks may vary by stage, which has important implications for therapy. Our objective was to apply a competing risk analysis in order to estimate these risks in a referred cohort of patients with CKD by stage at referral and identify risk factors associated with each outcome.


Retrospective cohort study.


3,273 patients with CKD stages 3-5 who were referred to the nephrology clinic at Sunnybrook Health Sciences Centre, Toronto, prior to December 31, 2008, with follow-up data available prior to December 31,2008.


CKD stage at time of referral; demographic, laboratory, and clinical characteristics.


ESRD, defined as the initiation of dialysis therapy or pre-emptive kidney transplantation, and death from any cause prior to ESRD.


Baseline laboratory data.


Over a median follow-up of 2.98 years, 459 patients (14%) developed ESRD and 540 (16%) died. Rates per 100 patient-years of ESRD versus death prior to ESRD for CKD stage 3A were 0.6 (95% CI, 0.1-1.0) versus 2.2 (95% CI, 1.2-3.1; P<0.001); for CKD stage 3B, 1.4 (95% CI, 0.8-2.1) versus 4.4 (95% CI, 3.3-5.6; P<0.001); for CKD stage 4, 7.7 (95% CI, 5.9-9.4) versus 8.0 (95% CI, 6.2-9.8; P=0.6); and for CKD stage 5, 41.4 (95% CI, 34.4-48.4) versus 9.4 (95% CI, 5.2-13.4; P<0.001). For those with CKD stage 4, we identified 12 variables associated with higher risk of ESRD and 7 variables associated with higher risk of death prior to ESRD.


A cohort analyzed retrospectively.


ESRD and death prior to ESRD incidence was most similar in CKD stage 4. We identified variables easily assessed at the time of referral that could discriminate between these risks.

Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.


Chronic kidney disease; end-stage renal disease; epidemiology; mortality

[PubMed - indexed for MEDLINE]
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