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

iNET-CKD Collaborators

Research output: Contribution to journalArticle

Abstract

Rates of chronic kidney disease (CKD) progression, end stage kidney disease (ESKD), 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 eight studies that are part of iNET-CKD, an international network of CKD cohort studies. Overall, the rate of CKD progression was 40 events/1000 person-year (95% confidence interval 39 - 41), 28 (27 - 29) for ESKD, 41 (40 - 42) for death, and 29 (28 - 30) for CVD events. However, standardized rates were highly heterogeneous across studies (over 92.5%). Interactions by study group on the association between baseline characteristics and outcomes were then identified. For example, the adjusted hazard ratio for CKD progression was 0.44 (95% confidence interval 0.35 – 0.56) for women vs. men among the Japanese (CKD-JAC), while it was 0.66 (0.59 – 0.75) among the Uruguayan (NRHP). The adjusted hazard ratio for ESKD was 2.02 (95% CI 1.88 – 2.17) per 10 units lower baseline eGFR among Americans (CRIC), while it was 3.01 (2.57 - 3.53) among Canadians (CanPREDDICT) (significant interaction for comparisons across all studies). The risks of CKD progression, ESKD, death, and CVD vary across countries even after accounting for the distributions of age, sex, comorbidities, and laboratory markers. Thus, our findings support the need for a better understanding of specific factors in different populations that explain this variation.

Original languageEnglish (US)
Pages (from-to)1217-1233
Number of pages17
JournalKidney International
Volume96
Issue number5
DOIs
StatePublished - Nov 2019

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Chronic Renal Insufficiency
Chronic Kidney Failure
Disease Progression
Comorbidity
Biomarkers
Confidence Intervals
Sex Distribution
Age Distribution
Cohort Studies
Demography
Mortality
Population

Keywords

  • CKD
  • CKD progression
  • epidemiology
  • international comparisons
  • risk factors

ASJC Scopus subject areas

  • Nephrology

Cite this

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

In: Kidney International, Vol. 96, No. 5, 11.2019, p. 1217-1233.

Research output: Contribution to journalArticle

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abstract = "Rates of chronic kidney disease (CKD) progression, end stage kidney disease (ESKD), 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 eight studies that are part of iNET-CKD, an international network of CKD cohort studies. Overall, the rate of CKD progression was 40 events/1000 person-year (95{\%} confidence interval 39 - 41), 28 (27 - 29) for ESKD, 41 (40 - 42) for death, and 29 (28 - 30) for CVD events. However, standardized rates were highly heterogeneous across studies (over 92.5{\%}). Interactions by study group on the association between baseline characteristics and outcomes were then identified. For example, the adjusted hazard ratio for CKD progression was 0.44 (95{\%} confidence interval 0.35 – 0.56) for women vs. men among the Japanese (CKD-JAC), while it was 0.66 (0.59 – 0.75) among the Uruguayan (NRHP). The adjusted hazard ratio for ESKD was 2.02 (95{\%} CI 1.88 – 2.17) per 10 units lower baseline eGFR among Americans (CRIC), while it was 3.01 (2.57 - 3.53) among Canadians (CanPREDDICT) (significant interaction for comparisons across all studies). The risks of CKD progression, ESKD, death, and CVD vary across countries even after accounting for the distributions of age, sex, comorbidities, and laboratory markers. Thus, our findings support the need for a better understanding of specific factors in different populations that explain this variation.",
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AU - Orlandi, Paula F.

AU - Huang, Jing

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AU - Oh, Kook Hwan

AU - Sola, Laura

AU - Cockwell, Paul

AU - Levin, Adeera

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AU - Zhang, Jianzhen

AU - Healy, Helen G.

AU - Cockwell, Paul

AU - Fenton, Anthony

AU - Orlandi, Paula F.

AU - Nessel, Lisa

AU - Go, Alan

AU - Appel, Lawrence

AU - Feldman, Harold I.

AU - Oh, Kook Hwan

AU - Ahn, Curie

AU - Chae, Dong Wan

AU - Han, Seung Hyeok

AU - Levin, Adeera

AU - Djurdjev, Ognjenka

AU - Tang, Mila

AU - Sola, Laura

AU - Rios, Pablo G.

AU - Gadola, Liliana

AU - Fukagawa, Masafumi

AU - Hamano, Takayuki

AU - Fujii, Naohiko

AU - Imaizumi, Takahiro

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AU - Kumar, Vivek

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N2 - Rates of chronic kidney disease (CKD) progression, end stage kidney disease (ESKD), 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 eight studies that are part of iNET-CKD, an international network of CKD cohort studies. Overall, the rate of CKD progression was 40 events/1000 person-year (95% confidence interval 39 - 41), 28 (27 - 29) for ESKD, 41 (40 - 42) for death, and 29 (28 - 30) for CVD events. However, standardized rates were highly heterogeneous across studies (over 92.5%). Interactions by study group on the association between baseline characteristics and outcomes were then identified. For example, the adjusted hazard ratio for CKD progression was 0.44 (95% confidence interval 0.35 – 0.56) for women vs. men among the Japanese (CKD-JAC), while it was 0.66 (0.59 – 0.75) among the Uruguayan (NRHP). The adjusted hazard ratio for ESKD was 2.02 (95% CI 1.88 – 2.17) per 10 units lower baseline eGFR among Americans (CRIC), while it was 3.01 (2.57 - 3.53) among Canadians (CanPREDDICT) (significant interaction for comparisons across all studies). The risks of CKD progression, ESKD, death, and CVD vary across countries even after accounting for the distributions of age, sex, comorbidities, and laboratory markers. Thus, our findings support the need for a better understanding of specific factors in different populations that explain this variation.

AB - Rates of chronic kidney disease (CKD) progression, end stage kidney disease (ESKD), 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 eight studies that are part of iNET-CKD, an international network of CKD cohort studies. Overall, the rate of CKD progression was 40 events/1000 person-year (95% confidence interval 39 - 41), 28 (27 - 29) for ESKD, 41 (40 - 42) for death, and 29 (28 - 30) for CVD events. However, standardized rates were highly heterogeneous across studies (over 92.5%). Interactions by study group on the association between baseline characteristics and outcomes were then identified. For example, the adjusted hazard ratio for CKD progression was 0.44 (95% confidence interval 0.35 – 0.56) for women vs. men among the Japanese (CKD-JAC), while it was 0.66 (0.59 – 0.75) among the Uruguayan (NRHP). The adjusted hazard ratio for ESKD was 2.02 (95% CI 1.88 – 2.17) per 10 units lower baseline eGFR among Americans (CRIC), while it was 3.01 (2.57 - 3.53) among Canadians (CanPREDDICT) (significant interaction for comparisons across all studies). The risks of CKD progression, ESKD, death, and CVD vary across countries even after accounting for the distributions of age, sex, comorbidities, and laboratory markers. Thus, our findings support the need for a better understanding of specific factors in different populations that explain this variation.

KW - CKD

KW - CKD progression

KW - epidemiology

KW - international comparisons

KW - risk factors

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