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 percent, rising to 1.01 percent, 7.51 percent, and 55.54 percent as eGFR fell.
For women, the lifetime risk was 0.67 percent in the highest eGFR group, rising to 0.73 percent, 3.21 percent, and 28.81 percent as eGFR fell.
The researchers noted that increasing life expectancies might alter the results slightly.
Hemmelgarn and colleagues pointed out that the study's strengths included a large 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 time point and the estimates do not describe the risk of untreated renal failure.