Skip to main content

Advertisement

SpringerLink
Log in

Excess mortality attributable to chronic kidney disease. Results from the PIRP project

  • Original Article
  • Published:
Journal of Nephrology Aims and scope Submit manuscript

Abstract

Although chronic kidney disease (CKD) has a high mortality rate, the estimation of CKD mortality burden in the general population may be challenging because CKD is not always listed as a cause of death in mortality registries. To overcome this limitation, relative survival was used to estimate the excess mortality attributable to CKD as compared to the general population using data of patients registered in the Prevenzione Insufficienza Renale Progressiva (PIRP) registry since 2005 and were followed up until 2013. Relative survival was the ratio of survival observed in CKD patients to the expected survival of the general population. Multivariate parametric survival analysis was used to identify factors predicting excess mortality. The relative survival of CKD patients at 9 years was 0.708. Survival was significantly lower in CKD patients with cardiovascular comorbidities, proteinuria, diabetes, anemia and high phosphate levels and in advanced CKD stages, males, older patients and those who underwent dialysis. Relative survival is a viable method to determine mortality attributable to CKD. Study limitations are that patients are representative only of CKD patients followed by nephrologists and that our follow-up duration may be relatively short as a model for mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Neovius M, Jacobson SH, Eriksson JK et al (2014) Mortality in chronic kidney disease and renal replacement therapy: a population-based cohort study. BMJ Open 4:e004251

    Article  PubMed  PubMed Central  Google Scholar 

  2. Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 13:1296–1305

  3. Elie C, De Rycke Y, Jais J, Landais P (2011) Appraising relative and excess mortality in population-based studies of chronic diseases such as end-stage renal disease. Clin Epidemiol 3:157–169

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tangri N, Kitsios GD, Inker LA, et al. (2013) Risk prediction models for patients with chronic kidney disease. Ann Intern Med 8:596–603

  5. Gebhart J, Posch F, Koder S et al (2015) Increased mortality in patients with the lupus anticoagulant : the Vienna lupus anticoagulant and thrombosis study (LATS). Blood 125:3477–3484

    Article  CAS  PubMed  Google Scholar 

  6. Davis JS, He V, Anstey NM, Condon JR (2014) Long term outcomes following hospital admission for sepsis using relative survival analysis: a prospective cohort study of 1092 patients with 5 year follow up. PLoS One 9:e112224

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nelson CP, Lambert PC, Squire IB, Jones DR (2008) Relative survival: what can cardiovascular disease learn from cancer? Eur Heart J 29:941–947

    Article  PubMed  Google Scholar 

  8. Rucci P, Mandreoli M, Gibertoni D et al (2014) A clinical stratification tool for chronic kidney disease progression rate based on classification tree analysis. Nephrol Dial Transplant 29:603–610

    Article  CAS  PubMed  Google Scholar 

  9. World Health Organization BMI Classification. http://apps.who.int/bmi/index.jsp?introPage = intro_3.html. Accessed 7 Nov 2014

  10. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter, Suppl 3:1–150

  11. Ederer F, Axtell L, Cutler S (1961) The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 6:101–121

  12. ISTAT (2014) Italian Population Life Tables. http://demo.istat.it/unitav2012/index.html?lingua = eng. Accessed 24 Nov 2014

  13. Hakulinen T, Seppä K, Lambert PC (2011) Choosing the relative survival method for cancer survival estimation. Eur J Cancer 47:2202–2210

    Article  PubMed  Google Scholar 

  14. Tripepi G, Jager KJ, Dekker FW, Zoccali C (2008) Testing for causality and prognosis: etiological and prognostic models. Kidney Int 74:1512–1515

    Article  PubMed  Google Scholar 

  15. Royston P, Lambert PC (2011) Flexible parametric survival analysis using Stata: beyond the Cox model, First edit. Stata Press, College Station, pp 91–124

    Google Scholar 

  16. Bellasi A, Mandreoli M, Baldrati L et al (2011) Chronic kidney disease progression and outcome according to serum phosphorus in mild-to-moderate kidney dysfunction. Clin J Am Soc Nephrol 6:883–891

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol Methods 7:147–177

    Article  PubMed  Google Scholar 

  18. White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30:377–399

    Article  PubMed  Google Scholar 

  19. Gondos A, Brenner H (2011) Relative survival of transplant patients: quantifying surplus mortality among renal transplant recipients compared with the general population. Transplantation 92:913–917

    Article  PubMed  Google Scholar 

  20. Nordio M, Limido A, Maggiore U et al (2012) Survival in patients treated by long-term dialysis compared with the general population. Am J Kidney Dis 59:819–828

    Article  PubMed  Google Scholar 

  21. Nordio M, Tessitore N, Feriani M et al (2013) Mortality in the Veneto population on renal replacement therapy. J Nephrol 26(Suppl 2):S23–S33

    Article  PubMed  Google Scholar 

  22. Van Walraven C, Manuel DG, Knoll G (2014) Survival trends in ESRD patients compared with the general population in the United States. Am J Kidney Dis 63:491–499

    Article  PubMed  Google Scholar 

  23. Santoro A, Mandreoli M (2014) Chronic renal disease and risk of cardiovascular morbidity-mortality. Kidney Blood Press Res 39:142–146

    Article  CAS  PubMed  Google Scholar 

  24. Gullion CM, Keith DS, Nichols GA, Smith DH (2006) Impact of comorbidities on mortality in managed care patients with CKD. Am J Kidney Dis 48:212–220

    Article  PubMed  Google Scholar 

  25. Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M et al (2010) Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 375:2073–2081

    Article  Google Scholar 

  26. Hemmelgarn BR, Manns BJ, Lloyd A et al (2010) Relation between kidney function, proteinuria, and adverse outcomes. JAMA 303:423–429

    Article  CAS  PubMed  Google Scholar 

  27. Eddington H, Hoefield R, Sinha S et al (2010) Serum phosphate and mortality in patients with chronic kidney disease. Clin J Am Soc Nephrol 5:2251–2257

    Article  PubMed  PubMed Central  Google Scholar 

  28. Palmer S, Hayen A, Macaskill P et al (2011) Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. JAMA 305:1119–1127

    Article  CAS  PubMed  Google Scholar 

  29. Singh A, Szczech L, Tang K et al (2006) Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 355:2085–2098

    Article  CAS  PubMed  Google Scholar 

  30. Pfeffer M, Burdmann E, Chen C et al (2009) A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 361:2019–2032

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was presented at the Poster Session CKD: Epidemiology and Outcomes—III at the ASN Kidney Week 2014 Annual Meeting, November 13-16 in Philadelphia, PA. De Amicis S., Ospedale G. Da Saliceto, Piacenza; David S., Ospedale Maggiore, Parma; Corradini M., Arcispedale S.Maria Nuova, Reggio Emilia; Caruso F., Ospedale Ramazzini, Carpi; Olmeda F., Ospedale Policlinico, Modena; Orsi C., Policlinico S.Orsola-Malpighi, Bologna; Cannarile DC., Policlinico S.Orsola-Malpighi, Bologna; Fantinati C., Ospedale S.Maria della Scaletta, Imola; Russo G., Ospedale S.Anna, Ferrara; Monti M., Ospedale S.Maria delle Croci, Ravenna; Gambaretto C., Ospedale Morgagni Pierantoni, Forlì; Ferri B., Ospedale Bufalini, Cesena; Flachi M., Ospedale degli Infermi, Rimini

Author information

Authors and Affiliations

  1. Department of Biomedical and Neuromotor Sciences, Unit of Hygiene and Biostatistics, University of Bologna, Bologna, Italy

    Dino Gibertoni, Paola Rucci & Maria Pia Fantini

  2. Nephrology and Dialysis Unit, Ospedale S.Maria della Scaletta, Imola, Italy

    Marcora Mandreoli

  3. Nephrology and Dialysis Unit, Ospedale degli Infermi, Rimini, Italy

    Angelo Rigotti

  4. Nephrology and Dialysis Unit, Ospedale G. Da Saliceto, Piacenza, Italy

    Roberto Scarpioni

  5. Nephrology, Dialysis and Hypertension Unit, Policlinico S.Orsola-Malpighi, Via P. Palagi, 9 40138, Bologna, Italy

    Antonio Santoro

Authors
  1. Dino Gibertoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcora Mandreoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paola Rucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Pia Fantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelo Rigotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberto Scarpioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio Santoro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dino Gibertoni.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest. The authors declare that no support was received for the current study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

On behalf of PIRP Nephrologists’ group

Authors in the mentioned group are present in acknowledgments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gibertoni, D., Mandreoli, M., Rucci, P. et al. Excess mortality attributable to chronic kidney disease. Results from the PIRP project. J Nephrol 29, 663–671 (2016). https://doi.org/10.1007/s40620-015-0239-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40620-015-0239-4

Keywords

Search

Navigation