PROGNOSTIC TRAJECTORIES OF KIDNEY FAILURE AND COMPETING RISKS ACROSS CKD STAGES IN PERU: FINDINGS FROM A NATIONAL SURVEILLANCE PROGRAM

Introduction:

Prognostic information for patients with chronic kidney disease (CKD) in Peru is limited, with scarce studies conducted on restricted populations. This study aimed to describe the cumulative incidence of kidney failure and death without kidney failure across CKD stages, including targeted subgroups that have been prioritized for CKD screening in Peru. The analysis spans CKD stages from G1 to G5, using data from a national renal health surveillance program.

Methods:

This retrospective cohort study utilized data from the Renal Health Surveillance Program (VISARE) of EsSalud, covering all 25 regions of Peru. A total of 128,591 CKD patients, classified from stages G1 to G5 according to the KDIGO 2012 guidelines, were included. The eGFR was calculated using the CKD-EPI 2009 equation. Patients were diagnosed between January 1, 2013, and December 31, 2022. The primary outcomes were kidney failure, defined as dialysis initiation or nephrologist-confirmed end-stage renal disease (ESRD), and death without kidney failure. Cumulative incidence functions accounting for the competing risk of death without kidney failure were used to evaluate patient prognosis. Subgroups were analyzed based on risk factors that have been targeted for active CKD screening in Peru, including diabetes mellitus, arterial hypertension, and individuals aged 55 years or older, allowing for the description of their prognostic trajectories.

Results:

The cumulative incidence of death without kidney failure increased with advancing CKD stage. At 5 years, the cumulative incidence of death without kidney failure for the overall population was 5.7% (95% CI 5.5 to 6%) in stage G1, 10.3% (95% CI 10 to 10.6%) in stage G2, 15.8% (95% CI 15.2 to 16.4%) in stage G3a, 25.4% (95% CI 24.4 to 26.4%) in stage G3b, and 26.7% (95% CI 25.1 to 28.3%) in stage G4. The cumulative incidence of kidney failure was lower in the early stages but increased significantly in advanced CKD, with 0.1% (95% CI 0.1 to 0.2%) in stage G1, 0.2% (95% CI 0.2 to 0.2%) in stage G2, 5.2% (95% CI 4.7 to 5.7%) in stage G3b, and 44.3% (95% CI 40.3 to 48.2%) in stage G5.

In patients with diabetes mellitus, the cumulative incidence of death without kidney failure at 5 years was 6.1% (95% CI 5.6 to 6.6%) in stage G1, 11.4% (95% CI 10.8 to 11.9%) in stage G2, and 25.7% (95% CI 23.7 to 27.6%) in stage G3b. Among hypertensive patients, the 5-year cumulative incidence was 5.3% (95% CI 4.9 to 5.6%) in stage G1 and 24.4% (95% CI 23.1 to 25.7%) in stage G3b. For patients aged 55 years or older, the incidence of death without kidney failure was 7.2% (95% CI 6.9 to 7.6%) in stage G1 and 26.2% (95% CI 25.1 to 27.2%) in stage G3b. These patterns were consistent across subgroups, with kidney failure incidence rising progressively with advancing CKD stages (Figure 1).

Conclusions:

This study provides a comprehensive overview of CKD prognosis across all stages, showing that death without kidney failure predominates in earlier stages, while progression to kidney failure becomes more frequent in stages G4 and G5. These findings underscore the need for early intervention and close monitoring of CKD patients, particularly those in high-risk subgroups such as those targeted for active screening in Peru. Tailored care for these populations could help prevent adverse outcomes and improve overall disease management.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.