Article Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist: A 7-Year Prospective Study

Background and objectivesRising prevalence of CKD requires active involvement of general practitioners to limit ESRD and mortality risk. However, the outcomes of patients with CKD exclusively managed by general practitioners are ill defined. Design, setting, participants, &measurementsWeprospectively evaluated 30,326 adult patients with nondialysis CKD stages 1–5 who had never received consultation in tertiary nephrology care recruited from 700 general practitioner offices in Italy during 2002 and 2003. CKD stages were classified as stages 1 and 2 (GFR$60 ml/min per 1.73 m2 and either albuminuria or an International Classification of Diseases, Ninth Revision, Clinical Modification code for kidney disease), stage 3a (GFR=59–45), stage 3b (GFR=44–30), stage 4 (GFR=29–15), and stage 5 (GFR,15). Primary outcome was the risk of ESRD (dialysis or transplantation) or all-cause death. ResultsOverall 64 % of patients were in stage 3a, and 4.5 % of patients were in stages 3b–5. Patients with stages 1 and 2 were younger, were predominantly men, more frequently had diabetes, and had lower prevalence of previous cardiovascular disease than patients with stages 3a–5. Hypertension was frequent in all CKD stages (80%–94%), whereas there was a lower prevalence of dyslipidemia, albuminuria, and obesity associated with more advanced CKD. During the follow-up (median=7.2 years; interquartile range=4.7–7.7), 6592 patients die