In patients with chronic kidney disease (CKD), adverse clinical events increase with disease stage and dialysis status, especially incident dialysis, reports a study in BMC Nephrology.
The analysis included data on 310,953 patients with CKD, identified from the UK Clinical Practice Research Datalink from 2004 through 2017. The study focused on selected adverse clinical events that may be difficult to measure in randomized trials. Event rates were compared by dialysis status and modality, baseline CKD stage, and observation period.
At index, 601 patients had dialysis-dependent CKD (DD-CKD). Among those with non-DD (NDD)-CKD, the disease stage was 3a in 71.7% of patients, stage 3b in 23.0%, stage 4 in 4.8%, and stage 5 in 0.4%. The median age was 67 years in the DD-CKD group versus 76 in the NDD-CKD group. Women accounted for 60.4% of patients with NDD-CKD, 39.2% with DD-CKD, and 39.1% with incident DD-CKD (IDD-CKD).
Patients with NDD-CKD had fewer comorbidities, higher hemoglobin, and lower C-reactive protein compared with the DD-CKD or IDD-CKD group. Within the NDD-CKD group, comorbidity was higher at lower estimated glomerular filtration rate levels.
Among patients receiving dialysis, the most frequent adverse clinical events were pneumonia/respiratory infection: incidence rate, 18.0 per 100 patient-years in the DD-CKD group and 19.9 in the IDD-CKD group compared with 9.3 in the NDD-CKD group. Incidence rates and all-event rates were generally higher in patients who were DD, including a 6.5-fold increase in hyperkalemia and a 6.9-fold increase in infection/sepsis in the DD-CKD group. In the IDD-CKD group, these increases were 7.4-fold and 9.4-fold, respectively.
Adverse event rates were higher during more recent observation periods. Mortality during follow-up was higher in the two dialysis groups and in patients with stage 4 or 5 disease in the NDD-CKD group. Adverse events and mortality were higher in patients receiving hemodialysis compared with peritoneal dialysis.
Among patients with CKD, rates of adverse clinical events and mortality are higher in patients who are DD and those with higher-stage CKD. Risks are particularly high in patients with IDD. The researchers conclude: “Our findings highlight the need to monitor patients with CKD for comorbidities and complications, as well as signs or symptoms of clinical adverse events, such as hyperkalemia, hypoglycemia, retinal disorders, seizures, and infection/sepsis.”
Reference
Little DJ, et al. Rates of adverse clinical events in patients with chronic kidney disease: Analysis of electronic health records from the UK Clinical Practice Research Datalink linked to hospital data. BMC Nephrol 2023; 24:91; doi: 10.1186/s12882-023-03119-z
