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

TY - JOUR

T1 - Chronic kidney disease, a useful trigger for proactive primary care? Mortality results from a large UK cohort

AU - Marks, Angharad

AU - MacLeod, Caitlin

AU - McAteer, Anne

AU - Murchie, Peter

AU - Fluck, Nicholas

AU - Smith, W. Cairns S.

AU - Prescott, Gordon J.

AU - Clark, Laura E.

AU - Ali, Tariq

AU - Black, Corri

PY - 2013/6

Y1 - 2013/6

N2 - 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.

AB - 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.

KW - Chronic disease

KW - Electronic medical records

KW - Medical co-morbidity

KW - Primary care

KW - Urology

UR - https://www.scopus.com/pages/publications/84878650884

U2 - 10.1093/fampra/cms079

DO - 10.1093/fampra/cms079

M3 - Article

C2 - 23248235

AN - SCOPUS:84878650884

SN - 0263-2136

VL - 30

SP - 282

EP - 289

JO - Family Practice

JF - Family Practice

IS - 3

ER -