Self-rated health and adverse events in CKD.

Robinson-Cohen C, Hall YN, Katz R, Rivara MB, de Boer IH, Kestenbaum BR, Himmelfarb J
Clin J Am Soc Nephrol. 2014 9 (12): 2044-51

PMID: 25301857 · PMCID: PMC4255401 · DOI:10.2215/CJN.03140314

BACKGROUND AND OBJECTIVES - Little is known about the utility of self-rated general health assessments in persons with moderate-to-severe CKD. This study examined the ability of a single self-rated health measure to predict all-cause mortality and kidney disease progression in a cohort of 443 patients with stages 3-4 CKD, recruited between 2005 and 2011, and followed until the end of 2012. The performance of models incorporating self-rated health measures was compared with previously published predictive models and more complex models comprising a multibiomarker panel.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - Participants were asked "In general, would you say your health is excellent, very good, good, fair, or poor?" Outcomes examined were time to all-cause mortality, kidney disease progression (initiation of RRT or 30% loss of eGFR), and a composite of these events. Model performances were compared using a nonparametric area under the curve (AUC) analysis.

RESULTS - Over a median follow-up of 3.3 years, 118 (27%) participants died and 138 (31%) had progression of kidney disease. Fair-to-poor self-rated health status was associated with significantly greater risks of mortality (fully adjusted hazard ratio [HR] for relative to good-to-excellent self-rated health, 2.76; 95% confidence interval [95% CI], 1.28 to 5.89), kidney disease progression (HR, 1.94; 95% CI, 1.49 to 2.56), and the combined end point (HR, 2.21; 95% CI, 1.66 to 2.96). For 3-year mortality prediction, the self-rated health model (AUC, 0.80; 95% CI, 0.76 to 0.85) had significantly higher AUCs than the base model (AUC, 0.71; 95% CI, 0.66 to 0.76) and the multibiomarker panel model (AUC, 0.74; 95% CI, 0.68 to 0.80) (P=0.03 and P=0.04, respectively).

CONCLUSIONS - A single, easily obtained measure of self-rated health helps identify patients with CKD at high risk of mortality and kidney disease progression. Routine evaluation of self-rated health may help target individuals who might benefit from more intensive monitoring strategies.

Copyright © 2014 by the American Society of Nephrology.

MeSH Terms (29)

Acid-Base Equilibrium Aged Albuminuria Area Under Curve Biomarkers C-Reactive Protein Cause of Death Creatinine Cystatin C Disease Progression Female Fibroblast Growth Factors Follow-Up Studies Glomerular Filtration Barrier Health Status Health Status Indicators Hemoglobins Humans Male Middle Aged Parathyroid Hormone Proportional Hazards Models Prospective Studies Renal Insufficiency, Chronic Renal Replacement Therapy Risk Factors Sensitivity and Specificity Uric Acid Vitamin D

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