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    • Study Gauges Renal Failure Risk in Middle Age (CME/CE)

    By Michael Smith, , MedPage TodayPublished: August 18, 2012Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

    About one in 40 men and one in 60 women in middle age have a high risk of developing end-stage renal disease (ESRD) in their lifetimes, researchers reported.

    In a massive population-based cohort study, the lifetime risk of ESRD for men at age 40 was 2.66%, according to Brenda Hemmelgarn, MD, PhD, of Foothills Medical Centre in Calgary, and colleagues.

    That was slightly higher than the 1.76% observed for 40-year-old women, Hemmelgarn and colleagues reported on-line in the Journal of the American Society of Nephrology.

    ESRD has both significant health consequences and requires high-cost treatments so good estimates of the lifetime risk would be of value for the public and for health policy makers, the researchers noted.

    Hemmelgarn and colleagues studied the incidence of ESRD over an 11-year period in the Western Canadian province of Alberta.

    The primary cohort included 1,459,937 men and 1,435,584 women, 18 or older, who had public health insurance in Alberta from April 1, 1997 to March 31, 2008. Alberta’s health insurance covers more than 99% of the province’s residents, the researchers noted. Participants were free of ESRD at the begin of the study.

    A subgroup of men and women who had an out-patient creatinine measurement from May 1, 2002 to March 31, 2008 were used to estimate lifetime ESRD risk by level of kidney function.

    They estimated cumulative ESRD incidence conditional on survival to ages of 50, 60, 70, 80, and 90 years. The estimated lifetime risk of ESRD, dependent on survival to the ages of 40, 50, 60, and 70 years, was calculated with and without adjustment for competing risk of death.

    Over about 26 million person-years of follow-up, 7,107 participants developed ESRD, defined as either dialysis or transplantation, Hemmelgarn and colleagues found.

    The risk of ESRD was consistently higher in men than in women, the researchers reported, and also was higher in those with reduced kidney function.

    Those in the creatinine subgroup were stratified according to their baseline estimated glomerular filtration rate (eGFR):

    At least 90 mL/min/1.73 m2 — 416,576 men and 579,673 women 60 to 89 mL/min/1.73 m2 — 335,387 men and 354,216 women 45 to 59 mL/min/1.73 m2 — 37,389 men and 52,273 women 30 to 44 mL/min/1.73 m2 — 12,190 men and 19,565 women Below 30 mL/min/1.73 m2 — Excluded from study

    During 7.5 million person-years of follow-up in the subcohort, there were 2,212 incident cases of ESRD, Hemmelgarn and colleagues reported.

    The lifetime risk of ESRD for 40-year-olds increased as baseline eGFR went down, the researchers found. Specifically, the lifetime risk of ESRD for men in the highest eGFR group was 0.72%, rising to 1.01%, 7.51%, and 55.54% as eGFR fell.

    For women, the lifetime risk was 0.67% in the highest eGFR group, rising to 0.73%, 3.21%, and 28.81% as eGFR fell.

    The researchers noted that increasing life expectancies might modify the results slightly.

    Hemmelgarn and colleagues pointed out that the study’s strengths included a massive population-based cohort and complete ascertainment of ESRD and mortality. Limitations, they wrote, include an inability to directly validate the results. Also, severity of the measure of exposure was categorized based on baseline kidney function at a single timepoint and the estimates do not describe the risk of untreated renal failure.

    The study had support from the Canadian Institutes of Health Research, the Canadian Diabetes Association, and Alberta Innovates — Health Solutions.

    The journal stated the authors had declared they no conflicts.

    for MedPage Today, is a three-time winner of the Science and Society Journalism Award of the Canadian Science Writers’ Association. After working for newspapers in several parts of Canada, he was the science writer for the Toronto Star before becoming a freelancer in 1994. His byline has appeared in New Scientist, Science, the Globe and Mail, United Press International, Toronto Life, Canadian Business, the Toronto Star, Marketing Computers, and many others. He is based in Toronto, and when not transforming dense science into compelling prose he can usually be found sailing.

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