Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in Spain: The MERENA observational cohort study
Entity
UAM. Departamento de Medicina Preventiva y Salud Pública y MicrobiologíaPublisher
BioMed CentralDate
2011-10-07Citation
10.1186/1471-2369-12-53
BMC Nephrology 12 (2011): 53
ISSN
1471-2369DOI
10.1186/1471-2369-12-53Editor's Version
http://www.biomedcentral.com/1471-2369/12/53Subjects
Cardiovascular morbidity; Hypertension control; Spain; MedicinaRights
© 2011 Martínez-Castelao et al; licensee BioMed Central Ltd.Abstract
To obtain information on cardiovascular morbidity, hypertension control, anemia and mineral
metabolism based on the analysis of the baseline characteristics of a large cohort of Spanish patients enrolled in
an ongoing prospective, observational, multicenter study of patients with stages 3 and 4 chronic kidney diseases
(CKD).
Methods: Multicenter study from Spanish government hospital-based Nephrology outpatient clinics involving 1129
patients with CKD stages 3 (n = 434) and 4 (n = 695) defined by GFR calculated by the MDRD formula. Additional
analysis was performed with GFR calculated using the CKD-EPI and Cockcroft-Gault formula.
Results: In the cohort as a whole, median age 70.9 years, morbidity from all cardiovascular disease (CVD) was very
high (39.1%). In CKD stage 4, CVD prevalence was higher than in stage 3 (42.2 vs 35.6% p < 0.024). Subdividing
stage 3 in 3a and 3b and after adjusting for age, CVD increased with declining GFR with the hierarchy (stage 3a <
stage 3b < stage 4) when calculated by CKD-EPI (31.8, 35.4, 42.1%, p 0.039) and Cockcroft-Gault formula (30.9, 35.6,
43.4%, p 0.010) and MDRD formula (32.5, 36.2, 42.2%,) but with the latter, it did not reach statistical significance (p
0.882). Hypertension was almost universal among those with stages 3 and 4 CKD (91.2% and 94.1%, respectively)
despite the use of more than 3 anti-hypertensive agents including widespread use of RAS blockers. Proteinuria (>
300 mg/day) was present in more than 60% of patients and there was no significant differences between stages 3
and 4 CKD (1.2 ± 1.8 and 1.3 ± 1.8 g/day, respectively). A majority of the patients had hemoglobin levels greater
than 11 g/dL (91.1 and 85.5% in stages 3 and 4 CKD respectively p < 0.001) while the use of erythropoiesisstimulating
agents (ESA) was limited to 16 and 34.1% in stages 3 and 4 CKD respectively. Intact parathyroid
hormone (i-PTH) was elevated in stage 3 and stage 4 CKD patients (121 ± 99 and 166 ± 125 pg/mL p 0.001)
despite good control of calcium-phosphorus levels.
Conclusion: This study provides an overview of key clinical parameters in patients with CKD Stages 3 and 4 where
delivery or care was largely by nephrologists working in a network of hospital-based clinics of the Spanish National
Healthcare System
Files in this item
Google Scholar:Martínez-Castelao, Alberto M.
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Górriz, José Luis
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Portolés Pérez, José María
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De Álvaro, Fernando
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Cases, Aleix I.
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Lũo, José
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Navarro-González, Juan F.
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Montes, Rafael
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De La Cruz-Troca, Juan José
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Natarajan, Aparna
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Batlle, Daniel C.
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