Chronic kidney disease, a useful trigger for proactive primary care? Mortality results from a large UK cohort

Angharad Marks, Caitlin MacLeod, Anne McAteer, Peter Murchie, Nicholas Fluck, W. Cairns S. Smith, Gordon J. Prescott, Laura E. Clark, Tariq Ali, Corri Black

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Background: Much of the emphasis for primary care management of chronic kidney disease (CKD) has focused on cardiovascular risk; however, many patients die of other causes. Aim: In order to guide future primary care management of CKD, we report the causes of death from a large UK CKD cohort linked to health care administrative data.

Design, setting and methods. The Grampian Laboratory Outcomes Mortality and Morbidity Study (GLOMMS-1) is a community cohort of people with established CKD, identified in 2003 and followed up for 6 years. Causes of death were available from death certificates. The relative likelihood of different causes of death was compared to the general population.

Results: When standardized for age and sex, mortality was 4.7 (95% confidence interval 4.5-4.9) times higher in GLOMMS-1 than the general population. Non-cardiovascular diseases accounted for 1076 (50.9%) of deaths, 3.7 times more common than in the age- and sex-matched general population. For those with stages 3 and 4 CKD, without cardiovascular disease at baseline, a non-cardiovascular cause accounted for almost two-thirds of deaths. In those 75 years and older, dementia and falls were among the main non-cardiovascular causes of death.

Conclusions: Mortality in those with CKD is high, with non-cardiovascular diseases accounting for more than half of all deaths. While there is evidence that intervention may benefit those at risk of cardiovascular death, most of the non-cardiovascular causes of death identified were not readily amenable to prevention. A mechanism to identify which patients may benefit from intervention to prevent cardiovascular disease or renal disease progression is needed.

Original languageEnglish
Pages (from-to)282-289
Number of pages8
JournalFamily Practice
Volume30
Issue number3
Early online date17 Jul 2012
DOIs
Publication statusPublished - Jun 2013

Keywords

  • Chronic disease
  • Electronic medical records
  • Medical co-morbidity
  • Primary care
  • Urology

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