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Kidney Int. 2018 Jun;93(6):1432-1441. doi: 10.1016/j.kint.2018.01.008. Epub 2018 Apr 12.

Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe.

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ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. Electronic address:
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Department of Nephrology, University of Campania "L. Vanvitelli", Naples, Italy.
Department of Nephrology, Nicosia General Hospital, Nicosia, Cyprus.
Renal Division, University Hospital Ghent, Ghent, Belgium.
Department of Clinical Epidemiology Research, University Medicine Greifswald, Greifswald, Germany.
Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
CNR-Institute of Clinical Physiology, Reggio Calabria, Italy.
Division of Nephrology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center/Network Aging Research, University of Heidelberg, Heidelberg, Germany.
Centre for Nephrology, University College London, London, UK.
Department of Renal Medicine, Salford Royal National Health Service Foundation Trust, Salford, UK.
Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
Department of Nephrology, Hospital Universitari de Bellvitge, Barcelona, Spain.
Department of Nephrology, Hospital Clínico Universitario INCLIVA, Departamento de Medicina, Valencia, Spain.
Department of Nephrology, St Olav Hospital/Faculty of Medicine, Norwegian University of Science and Technology, Norway.
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Department of Biomedical and Neuromotor Sciences, Unit of Hygiene and Biostatistics, University of Bologna, Bologna, Italy.
Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.


The incidence of renal replacement therapy varies across countries. However, little is known about the epidemiology of chronic kidney disease (CKD) outcomes. Here we describe progression and mortality risk of patients with CKD but not on renal replacement therapy at outpatient nephrology clinics across Europe using individual data from nine CKD cohorts participating in the European CKD Burden Consortium. A joint model assessed the mean change in estimated glomerular filtration rate (eGFR) and mortality risk simultaneously, thereby accounting for mortality risk when estimating eGFR decline and vice versa, while also correcting for the measurement error in eGFR. Results were adjusted for important risk factors (baseline eGFR, age, sex, albuminuria, primary renal disease, diabetes, hypertension, obesity and smoking) in 27,771 patients from five countries. The adjusted mean annual eGFR decline varied from 0.77 (95% confidence interval 0.45, 1.08) ml/min/1.73m2 in the Belgium cohort to 2.43 (2.11, 2.75) ml/min/1.73m2 in the Spanish cohort. As compared to the Italian PIRP cohort, the adjusted mortality hazard ratio varied from 0.22 (0.11, 0.43) in the London LACKABO cohort to 1.30 (1.13, 1.49) in the English CRISIS cohort. These results suggest that the eGFR decline showed minor variation but mortality showed the most variation. Thus, different health care organization systems are potentially associated with differences in outcome of patients with CKD within Europe. These results can be used by policy makers to plan resources on a regional, national and European level.


ACE inhibitors; cardiovascular disease; chronic kidney disease; diabetes; obesity

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