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Lancet. 2014 May 24;383(9931):1831-43. doi: 10.1016/S0140-6736(14)60384-6.

Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure.

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Division of Nephrology, IIS-Fundacion Jimenez Diaz, Madrid, Spain; Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; Red de Investigacion Renal (REDINREN), Madrid, Spain; Instituto Reina Sofia de Investigaciones Nefrológicas (IRSIN), Madrid, Spain. Electronic address:
PaArhon University Hospital, "Grigore T Popa" University of Medicine and Pharmacy, Iasi, Romania.
Clinic for Renal and Hypertensive Disease, Saarland University Medical Centre, Homburg/Saar, Germany.
Department of Nephrology, Nutrition, and Dialysis, Centre Hospitalier Lyon Sud, Carmen-CENS, Université de Lyon, Lyon, France.
Renal and Transplantation Department, Guy's and St Thomas' Hospitals, London, UK.
Department of Nephrology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey.
Nephrology, Hypertension, and Renal Transplantation Unit, Ospedali Riuniti and CNR-IFC "Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension", Reggio Calabria, Italy.
Division of Nephrology, Ambroise Paré Hospital, Paris Ile de France Ouest University (UVSQ), Paris, France; INSERM U1088, Amiens, France.
INSERM, Centre d'Investigations Cliniques-1433 and INSERM U1116, Nancy, France; Centre d'Investigations Cliniques, CHU Nancy, Vandoeuvre lès Nancy, France; Centre d'Investigations, Université de Lorraine, Vandoeuvre lès Nancy, France; Association Lorraine pour le Traitement de l'Insuffisance Rénale, Vandoeuvre lès Nancy, France.
Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium.
Department of Nephrology, Endocrinology, and Metabolic Diseases, Medical University of Silesia, Katowice, Poland.
INSERM U970, Hopital Européen Georges Pompidou, Paris, France.


Patients with chronic kidney failure--defined as a glomerular filtration rate persistently below 15 mL/min per 1·73 m(2)--have an unacceptably high mortality rate. In developing countries, mortality results primarily from an absence of access to renal replacement therapy. Additionally, cardiovascular and non-cardiovascular mortality are several times higher in patients on dialysis or post-renal transplantation than in the general population. Mortality of patients on renal replacement therapy is affected by a combination of socioeconomic factors, pre-existing medical disorders, renal replacement treatment modalities, and kidney failure itself. Characterisation of the key pathophysiological contributors to increased mortality and cardiorenal risk staging systems are needed for the rational design of clinical trials aimed at decreasing mortality. Policy changes to improve access to renal replacement therapy should be combined with research into low-cost renal replacement therapy and optimum clinical care, which should include multifaceted approaches simultaneously targeting several of the putative contributors to increased mortality.

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