期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 66, 期 2, 页码 231-239出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2015.01.016
关键词
End-stage renal disease (ESRD); chronic kidney disease (CKD); hospitalization; validation studies; chronic kidney failure; untreated renal failure; renal replacement therapy (RRT); sensitivity and specificity; Atherosclerosis Risk in Communities (ARIC) Study; US Renal Data System (USRDS)
资金
- National Heart, Lung and Blood Institute (NHLBI) [HHSN268201100005C, HHSN268201100006C, HH SN268201100007C, HHSN268201100008C, HHSN2682011000 09C, HHSN268201100010C, HHSN268201100011C, HHSN 268201100012C]
- NHLBI Cardiovascular Epidemiology training grant [T32 HL007024]
- National Institute of Diabetes and Digestive and Kidney Diseases [K08 DK092287]
Background: Linkage to the US Renal Data System (USRDS) registry commonly is used to identify end-stage renal disease (ESRD) cases, or kidney failure treated with dialysis or transplantation, but it underestimates the total burden of kidney failure. This study validates a kidney failure definition that includes both kidney failure treated and not treated by dialysis or transplantation. It compares kidney failure risk factors and outcomes using this broader definition with USRDS-identified ESRD risk factors and outcomes. Study Design: Diagnostic test study with stratified random sampling of hospitalizations for chart review. Setting & Participants: Atherosclerosis Risk in Communities Study (n = 11,530; chart review, n = 546). Index Test: USRDS-identified ESRD; treated or untreated kidney failure defined by USRDS-identified ESRD or International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification (ICD-9-CM/ ICD-10-CM) code for hospitalization or death. Reference Test: For ESRD, determination of permanent dialysis therapy or transplantation; for kidney failure, determination of permanent dialysis therapy, transplantation, or estimated glomerular filtration rate, 15 mL/min/1.73 m(2). Results: During 13 years' median follow-up, 508 kidney failure cases were identified, including 173 (34.1%) from the USRDS registry. ESRD and kidney failure incidence were 1.23 and 3.66 cases per 1,000 person-years in the overall population and 1.35 and 6.59 cases per 1,000 person-years among participants older than 70 years, respectively. Other risk-factor associations were similar between ESRD and kidney failure, except diabetes and albuminuria, which were stronger for ESRD. Survivals at 1 and 5 years were 74.0% and 24.0% for ESRD and 59.8% and 31.6% for kidney failure, respectively. Sensitivity and specificity were 88.0% and 97.3% comparing the kidney failure ICD-9-CM/ICD-10-CM code algorithm to chart review; for USRDS-identified ESRD, sensitivity and specificity were 94.9% and 100.0%. Limitations: Some medical charts were incomplete. Conclusions: A kidney failure definition including treated and untreated disease identifies more cases than linkage to the USRDS registry alone, particularly among older adults. Future studies might consider reporting both USRDS-identified ESRD and a more inclusive kidney failure definition. (C) 2015 by the National Kidney Foundation, Inc.
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