Risk Factors and Prevention of End Stage Renal Disease in Uruguay

Figures & data

Figure 1 Incidence and prevalence rate in dialysis treatment. Data from the Uruguayan Dialysis Registry.

Table 1 ESRD incident rates by time periods by diagnoses, per million population (pmp). From the Uruguayan Dialysis Registry

	All ESRD (95% C.I.)	Vascular nephropathy (95% C.I.)	Diabetic nephropathy (95% C.I.)	Glomerulo nephritis (95% C.I.)	Obstructive nephropathy (95% C.I.)
1981–1985	49.4 (41.4 –57.5)	6.6 (3.7–9.5)	6.4 (3.5–9.3)	13.4 (9.3–17.5)	4.9 (2.4–7.4)
1986–1990	73.3 (63.6–83.0)	15.2 (10.8–19.6)	9.7 (6.2–13.2)	11.7 (7.8–15.6)	7.2 (4.2–10.2)
1991–1995	110.8 (99.1–122.5)	23.0 (17.7–28.3)	15.1 (10.7–19.4)	17.1 (12.5–21.7)	12.7 (8.7–16.7)
1996–2000	130.6 (118.2–143.0)	34.2 (27.7–40.7)	21.2 (16.2–26.3)	17.7 (13.1–22.3)	12.9 (8.9–16.9)
2001–2002	130.0 (117.7–142.2)	33.1 (26.8–39.4)	26.7 (21.2–32.2)	15.7 (11.4–20.0)	13.1 (9.2–17.0)

*most frequent diagnoses.

Figure 2 Annual incidence of ESRD secondary to diabetic nephropathy by time periods (95% confidence interval). Data from the Uruguayan Dialysis Registry.

Table 2 Relative risk of ESRD, adjusted for confounding factors. From the Uruguayan Registry of Glomerulonephritis

	Relative risk	95% confidence interval	p
Age (years old) N: 1344; Reference: <20
20–44	1.42	1.07–1.88	0.017
45–64	1.77	1.31–2.39	<0.001
≥65	2.59	1.82–3.68	<0.001
Initial serum creatinine (mg/dl) N: 1307; Reference: <1.5
1.5–2.9	3.81	2.76–5.24	<0.001
3.0–5.9	10.25	7.45–14.12	<0.001
≥6.0	22.71	16.29–31.67	<0.001
Stage of chronic kidney disease^†; Reference: Stage 1
Stage 2	1.01	0.59–1.71	NS
Stage 3	2.82	1.79–4.45	<0.001
Stage 4	8.18	5.25–12.75	<0.001
Stage 5	17.58	11.35–27.22	<0.001
Proteinuria (g/day; average in the follow-up) N: 1014; Reference: <1.0
1.0–3.5	3.76	2.34–6.04	<0.001
>3.5	6.82	4.21–11.07	<0.001
Systolic blood pressure (mmHg; average in the follow-up) N: 1047; Reference: <115 (quintile 1)
115–126 (quintile 2)	1.38	0.73–2.61	NS
127–139 (quintile 3)	1.62	0.89–2.97	NS
140–155 (quintile 4)	2.18	1.18–4.05	0.013
>155 (quintile 5)	3.53	1.94–6.42	<0.001
Treatment (ACE inhibitors or AT1 receptor blockers) N: 1093; Reference: No Treated
Yes, treated	0.19		<0.001

*Cox proportional regression model.

^†Estimated glomerular filtration rate by the abbreviated MDRD equation.

Table 3 Indicators to evaluate the Prevention Program. Data from the Uruguayan Registry of Glomerulonephritis

	1980–1989, in % (95% C.I.)	1990–1994, in % (95% C.I.)	1995–1999, in % (95% C.I.)	2000–2004, in % (95% C.I.)
Referral to nephrologists
Patients referred at stage 1 of CKD	16.8 (15.0–18.6)	16.1 (14.3–17.9)	20.2 (18.3–22.1)	32.4 (30.1–34.7)
Patients referred at stage 5 of CKD	22.8 (20.8–24.8)	24.6 (22.5–26.7)	24.2 (22.1–26.3)	17.2 (15.4–19.0)
Patients referred at stage 1 of CKD and systolic blood pressure <120 mmHg	18.0 (14.1–21.9)	40.0 (35.0–45.0)	39.5 (34.5–44.5)	44.0 (38.9–49.1)
Patients referred at stage 1 of CKD and systolic blood pressure ≥160 mmHg	16.0 (12.3–19.7)	10.9 (7.7–14.1)	7.9 (5.2–10.6)	5.3 (3.0–7.6)
Current practice and goals of treatment
Patients with proteinuria <1.0 g/day (average in the follow-up)	14.7 (12.5–16.9)	34.4 (31.5–37.3)	32.1 (29.3–34.9)	34.5 (31.6–37.4)
Patients with systolic blood pressure ≤120 mmHg (average in the follow-up)	20.8 (18.4–23.2)	30.7 (27.9–33.5)	28.4 (25.7–31.1)	43.4 (40.4–46.4)
Patients with diastolic blood pressure ≤80 mmHg (average in the follow-up)	37.1 (34.2–40.0)	49.2 (46.2–52.2)	55.4 (52.4–58.4)	66.3 (63.5–69.1)
Patients taking ACE inhibitors or AT1 receptor blockers	—	22.5 (20.0–25.0)	38.0 (35.1–40.9)	41.8 (38.8–44.8)
Outcome
Patients in clinical remission	13.7 (9.8–17.6)	18.0 (13.9–22.1)	19.5 (15.6–23.4)	22.1 (17.8–26.4)
Frequency of ESRD in the first three months of registry	10.5 (7.1–13.9)	14.5 (10.9–18.1)	13.8 (10.6–17.0)	7.6 (5.5–9.7)
ESRD rate after the third month of registry (per 100 patients)	6.72 (3.6–9.8)	5.51 (2.8–8.2)	7.05 (5.0–9.1)

Figure 3 Relative risk of end stage renal disease in the first three months of Registry. Data adjusted for age, gender, diagnosis, and initial serum creatinine. Data from the Uruguayan Registry of Glomerulonephritis.

Table 4 Patient characteristics at the first consultation., from the Registry of Chronic Kidney Disease. Pilot Program of Renal Healthcare of Montevideo

	Relative frequency(%)	95% confidence interval
Age
<40 years old	5.1	2.6–7.6
40–59 years old	32.2	26.9–37.5
60–79 years old	44.5	38.9–50.1
≥80 years old	18.2	13.9–22.5
Gender (Female)	54.1	48.5–59.7
Most frequent diagnoses
Vascular nephropathy	48.8	43.2–54.4
Diabetic nephropathy	19.1	14.7–23.5
Obstructive nephropathy	6.3	3.6–9.0
Glomerulonephritis	5.0	2.5–7.5
Stages of CKD
Stage I	2.8	0.9–4.7
Stage II	9.3	6.0–12.6
Stage III	65.4	60.0–70.8
Stage IV	18.3	13.9–22.7
Stage V	4.2	1.9–6.5
Most frequent risk factors
Hypertension	88.2	84.6–91.8
Dyslipidemias	60.1	54.6–65.6
Diabetes	38.4	32.9–43.9
Obesity	37.9	32.4–43.4

*First ten months / N: 303.

Table 5 Analysis of three months follow-up data, from the Registry of Chronic Kidney Disease. Pilot Program of Renal Healthcare of Montevideo

	First consultation	Third month	p
Systolic blood pressure mmHg (mean)	152	147	NS
Diastolic blood pressure mmHg (mean)	85	81	NS
Glomerular filtration rate mL/min/1.73m^2 (mean)	41	42	NS
Cholesterol mg/dL (mean)	233	206	<0.05^†
LDL Cholesterol mg/dL (mean)	140	121	<0.05^†
Treated with statins (%)	12	40	<0.05^‡
Treated with ACE inhibitors or AT1 receptor blockers (%)	63	82	<0.05^‡

*n: 116.

^†t-test (dependent samples).

^‡z-test for proportion comparison.