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CKD progression and mortality among older patients with diabetes.

Publication ,  Journal Article
Patel, UD; Young, EW; Ojo, AO; Hayward, RA
Published in: Am J Kidney Dis
September 2005

BACKGROUND: Chronic kidney disease (CKD) is clearly associated with an increased risk for adverse outcomes; however, the cumulative impact of renal and cardiac complications in high-risk populations is not known. In addition, little is known about patterns of nephrology care in patients with CKD. METHODS: We conducted a retrospective longitudinal cohort study assessing CKD prevalence and progression, associations with all-cause mortality, and variations in patterns of nephrology consultation in older patients with diabetes in a vertically integrated health care system. RESULTS: A total of 12,570 patients within a 7-Veterans Affairs hospital service network in 1998 to 1999 were identified by means of computerized records. Nearly half (48%) were affected with CKD; most had mild to moderate CKD. After an observation period of 3 years, mortality rates in those unaffected with CKD were high (4.7 deaths/100 person-years) and increased substantially with progressive CKD (eg, 20.1 deaths/100 person-years with an estimated glomerular filtration rate [GFR] of 15 to 29 mL/min/1.73 m2 [0.25 to 0.48 mL/s/1.73 m2]). Only 7.2% of patients with CKD had a nephrology visit during the entire 5-year study period. Although visits increased with more advanced CKD, only 32% of patients with an estimated GFR of 15 to 29 mL/min/1.73 m2 had been seen in a nephrology clinic. We also found that nephrology referrals were driven preferentially by elevations in serum creatinine levels, rather than low GFRs. CONCLUSION: Many in this cohort of older patients with diabetes are affected with CKD. Mortality rates are high, and mortality risks associated with CKD amplify those of other risk factors. Nephrology visits are low and may represent an unexploited resource for improving CKD management. Underrecognition of CKD likely is related to overestimation of kidney function by relying on serum creatinine level in elderly patients.

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Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

September 2005

Volume

46

Issue

3

Start / End Page

406 / 414

Location

United States

Related Subject Headings

  • Veterans
  • Urology & Nephrology
  • Risk
  • Retrospective Studies
  • Referral and Consultation
  • Prevalence
  • Nephrology
  • Middle Aged
  • Male
  • Kidney Diseases
 

Citation

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Chicago
ICMJE
MLA
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Patel, U. D., Young, E. W., Ojo, A. O., & Hayward, R. A. (2005). CKD progression and mortality among older patients with diabetes. Am J Kidney Dis, 46(3), 406–414. https://doi.org/10.1053/j.ajkd.2005.05.027
Patel, Uptal D., Eric W. Young, Akinlolu O. Ojo, and Rodney A. Hayward. “CKD progression and mortality among older patients with diabetes.Am J Kidney Dis 46, no. 3 (September 2005): 406–14. https://doi.org/10.1053/j.ajkd.2005.05.027.
Patel UD, Young EW, Ojo AO, Hayward RA. CKD progression and mortality among older patients with diabetes. Am J Kidney Dis. 2005 Sep;46(3):406–14.
Patel, Uptal D., et al. “CKD progression and mortality among older patients with diabetes.Am J Kidney Dis, vol. 46, no. 3, Sept. 2005, pp. 406–14. Pubmed, doi:10.1053/j.ajkd.2005.05.027.
Patel UD, Young EW, Ojo AO, Hayward RA. CKD progression and mortality among older patients with diabetes. Am J Kidney Dis. 2005 Sep;46(3):406–414.
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

September 2005

Volume

46

Issue

3

Start / End Page

406 / 414

Location

United States

Related Subject Headings

  • Veterans
  • Urology & Nephrology
  • Risk
  • Retrospective Studies
  • Referral and Consultation
  • Prevalence
  • Nephrology
  • Middle Aged
  • Male
  • Kidney Diseases