Secular Changes in Mortality and Hospitalization over Time in People with Kidney Failure or Severe CKD as Compared with Other Noncommunicable Diseases

ABSTRACT: Significance Statement Unlike other noncommunicable diseases such as coronary disease and cancer, few new effective treatments have been developed for kidney failure or CKD in recent years. This retrospective cohort study included 548,609 people in Alberta, Canada with an incident noncommunicable disease, including those with kidney failure on renal replacement (KF-RRT) or severe CKD, who were diagnosed in 2004 through 2015. The authors found that patients with CKD and KF-RRT experienced secular reductions in mortality and mean annual days in the hospital at 1 and 5 years comparable with those experienced by patients with other common noncommunicable diseases, including myocardial infarction, diabetes, and certain malignancies. This contradicts the commonly held perception that outcomes associated with CKD or kidney failure have improved more slowly than those for other major noncommunicable diseases. Visual Abstract

Background

Few new treatments have been developed for kidney failure or CKD in recent years, leading to perceptions of slower improvement in outcomes associated with CKD or kidney failure than for other major noncommunicable diseases.

Methods

Our retrospective cohort study included 548,609 people with an incident noncommunicable disease, including cardiovascular diseases, diabetes, various cancers, and severe CKD or kidney failure treated with renal replacement (KF-RRT), treated in Alberta, Canada, 2004–2015. For each disease, we assessed presence or absence of 8 comorbidities; we also compared secular trends in relative (compared to a referent year of 2004) and absolute risks of mortality and mean annual days in the hospital associated with each disease after 1 year and 5 years.

Results

Comorbidities increased significantly in number over time for all noncommunicable diseases except diabetes, and increased most rapidly for CKD and KF-RRT. Significant but relatively small reductions over time in the risk ratio of mortality at 1 year occurred for nearly all noncommunicable diseases. Secular trends in the absolute risk of mortality were similar; CKD and KF-RRT had a relatively favorable ranking at 1 year. Breast cancer, KF-RRT, diabetes, and colorectal cancer displayed the largest relative reductions in number of hospital days at 1 year. Significant absolute reductions in the number of hospital days were observed for both KF-RRT and CKD; the former had the highest absolute reduction among all noncommunicable diseases. Results were similar at 5 years.

Conclusions

We observed secular reductions in mortality and annual hospital days at 1 year and 5 years among incident patients with KF-RRT and severe CKD, as well as several other common noncommunicable diseases.

SUBMITTER: Tonelli M 

PROVIDER: S-EPMC7608960 | biostudies-literature |

REPOSITORIES: biostudies-literature