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Long-term health outcomes of people with reduced kidney function in the UK : a modelling study using population health data
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Taal, Maarten W., Schlackow, Iryna, Simons, Claire, Oke, Jason, Feakins, Benjamin, O’Callaghan, Christopher A., Hobbs, F. D Richard, Lasserson, Daniel, Stevens, Richard J., Perera, Rafael and Mihaylova, Borislava (2020) Long-term health outcomes of people with reduced kidney function in the UK : a modelling study using population health data. PLoS Medicine, 17 (12). e1003478. doi:10.1371/journal.pmed.1003478 ISSN 1549-1277.
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Official URL: http://dx.doi.org/10.1371/journal.pmed.1003478
Abstract
Background
People with reduced kidney function have increased cardiovascular disease (CVD) risk. We present a policy model that simulates individuals’ long-term health outcomes and costs to inform strategies to reduce risks of kidney and CVDs in this population.
Methods and findings
We used a United Kingdom primary healthcare database, the Clinical Practice Research Datalink (CPRD), linked with secondary healthcare and mortality data, to derive an open 2005–2013 cohort of adults (≥18 years of age) with reduced kidney function (≥2 measures of estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m2 ≥90 days apart). Data on individuals’ sociodemographic and clinical characteristics at entry and outcomes (first occurrences of stroke, myocardial infarction (MI), and hospitalisation for heart failure; annual kidney disease stages; and cardiovascular and nonvascular deaths) during follow-up were extracted. The cohort was used to estimate risk equations for outcomes and develop a chronic kidney disease–cardiovascular disease (CKD–CVD) health outcomes model, a Markov state transition model simulating individuals’ long-term outcomes, healthcare costs, and quality of life based on their characteristics at entry. Model-simulated cumulative risks of outcomes were compared with respective observed risks using a split-sample approach. To illustrate model value, we assess the benefits of partial (i.e., at 2013 levels) and optimal (i.e., fully compliant with clinical guidelines in 2019) use of cardioprotective medications. The cohort included 1.1 million individuals with reduced kidney function (median follow-up 4.8 years, 45% men, 19% with CVD, and 74% with only mildly decreased eGFR of 60–89 mL/min/1.73 m2 at entry). Age, kidney function status, and CVD events were the key determinants of subsequent morbidity and mortality. The model-simulated cumulative disease risks corresponded well to observed risks in participant categories by eGFR level. Without the use of cardioprotective medications, for 60- to 69-year-old individuals with mildly decreased eGFR (60–89 mL/min/1.73 m2), the model projected a further 22.1 (95% confidence interval [CI] 21.8–22.3) years of life if without previous CVD and 18.6 (18.2–18.9) years if with CVD. Cardioprotective medication use at 2013 levels (29%–44% of indicated individuals without CVD; 64%–76% of those with CVD) was projected to increase their life expectancy by 0.19 (0.14–0.23) and 0.90 (0.50–1.21) years, respectively. At optimal cardioprotective medication use, the projected health gains in these individuals increased by further 0.33 (0.25–0.40) and 0.37 (0.20–0.50) years, respectively. Limitations include risk factor measurements from the UK routine primary care database and limited albuminuria measurements.
Conclusions
The CKD–CVD policy model is a novel resource for projecting long-term health outcomes and assessing treatment strategies in people with reduced kidney function. The model indicates clear survival benefits with cardioprotective treatments in this population and scope for further benefits if use of these treatments is optimised
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > RC Internal medicine | |||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | |||||||||
Library of Congress Subject Headings (LCSH): | Kidneys -- Diseases, Kidneys -- Diseases -- Patients, Heart failure, Cardiovascular system—Diseases—Patients | |||||||||
Journal or Publication Title: | PLoS Medicine | |||||||||
Publisher: | Public Library of Science | |||||||||
ISSN: | 1549-1277 | |||||||||
Official Date: | 16 December 2020 | |||||||||
Dates: |
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Volume: | 17 | |||||||||
Number: | 12 | |||||||||
Article Number: | e1003478 | |||||||||
DOI: | 10.1371/journal.pmed.1003478 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 22 December 2020 | |||||||||
Date of first compliant Open Access: | 22 December 2020 | |||||||||
RIOXX Funder/Project Grant: |
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