Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization
Open accessAbstract
BACKGROUND: End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined. METHODS: We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation. We examined the multivariable association between the estimated GFR and the risks of death, cardiovascular events, and hospitalization. RESULTS: The median follow-up was 2.84 years, the mean age was 52 years, and 55 percent of the group were women. After adjustment, the risk of death increased as the GFR decreased below 60 ml per minute per 1.73 m2 of body-surface area: the adjusted hazard ratio for death was 1.2 with an estimated GFR of 45 to 59 ml per minute per 1.73 m2 (95 percent confidence interval, 1.1 to 1.2), 1.8 with an estimated GFR of 30 to 44 ml per minute per 1.73 m2 (95 percent confidence interval, 1.7 to 1.9), 3.2 with an estimated GFR of 15 to 29 ml per minute per 1.73 m2 (95 percent confidence interval, 3.1 to 3.4), and 5.9 with an estimated GFR of less than 15 ml per minute per 1.73 m2 (95 percent confidence interval, 5.4 to 6.5). The adjusted hazard ratio for cardiovascular events also increased inversely with the estimated GFR: 1.4 (95 percent confidence interval, 1.4 to 1.5), 2.0 (95 percent confidence interval, 1.9 to 2.1), 2.8 (95 percent confidence interval, 2.6 to 2.9), and 3.4 (95 percent confidence interval, 3.1 to 3.8), respectively. The adjusted risk of hospitalization with a reduced estimated GFR followed a similar pattern. CONCLUSIONS: An independent, graded association was observed between a reduced estimated GFR and the risk of death, cardiovascular events, and hospitalization in a large, community-based population. These findings highlight the clinical and public health importance of chronic renal insufficiency.
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Older individuals (age >75 years) or with life expectancy <20 years are at moderately increased risk of cardiovascular mortality.
“they will be at moderately increased risk of cardiovascular mortality, with severity of chronic kidney disease (CKD) acting as a risk multiplier (458,459).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [458]
The Outcomes According to the Estimated GFR section reports that cardiovascular-event risk rises as estimated GFR falls, supporting the CKD-severity part of the citing sentence. It measures death from any cause separately, not cardiovascular mortality, and does not establish the stated risk specifically for people over 75 or with life expectancy under 20 years. The Statistical Analysis section uses age categories but does not supply those claimed subgroup findings; page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSeverity of chronic kidney disease acts as a risk multiplier for cardiovascular mortality.
“with severity of chronic kidney disease (CKD) acting as a risk multiplier (458,459).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [458]
The Abstract reports a graded association between lower estimated GFR and higher risks of death and cardiovascular events. The outcomes section specifies that death was measured from any cause and cardiovascular events were defined by hospitalization, so these passages do not establish a graded increase in cardiovascular mortality specifically. The study reports an association, not a causal multiplier. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOlder individuals (age >75 years) or with life expectancy <20 years may not be at increased risk of kidney failure requiring replacement therapy during their lifetimes.
“While older individuals (age >75 years) or with life expectancy <20 years may not be at increased risk of kidney failure requiring replacement therapy during their lifetimes”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [458]
The Outcomes According to the Estimated GFR section reports how many participants began dialysis or underwent transplantation during a median 2.84-year follow-up. Neither that section nor the other passages located by searches for age over 75 and life expectancy under 20 years assesses whether those groups are at increased risk of kidney failure requiring replacement therapy during their lifetimes. (LLM, conf=0.74)
Experimental — accuracy not yet measuredAlbuminuria is an early marker of nephropathy and predicts both risk of kidney failure and cardiovascular disease independently of eGFR.
“Albuminuria is an early marker of nephropathy and predicts both risk of kidney failure and CVD independently of eGFR.43,682”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [682]
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- Authors
- Go, A. S., Chertow, G. M., Fan, D., McCulloch, C. E., & Hsu, C.-Y.
- Affiliations
- Kaiser Permanente (US)
- University of California, San Francisco (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2004-09-23
- Volume
- 351
- Issue
- 13
- Pages
- 1296-1305
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2145632027
- Cited by
- 11,369
- References
- 41
- Citations by year
- 2026: 291 · 2025: 396 · 2024: 445 · 2023: 495 · 2022: 549 · 2021: 584 · 2020: 597 · 2019: 587 · 2018: 545 · 2017: 590 · 2016: 625 · 2015: 675 · 2014: 637 · 2013: 670 · 2012: 663
- FWCI
- 179.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058411, R01 DK58411)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- chronic kidney disease, glomerular filtration rate, reduced renal function, mortality, cardiovascular events, hospitalization, end-stage renal disease, serum creatinine
- MeSH terms
- Aged, Analysis of Variance, Cardiovascular Diseases, Chronic Disease, Creatinine, Female, Follow-Up Studies, Glomerular Filtration Rate, Hospitalization, Humans, Kidney Diseases, Male, Middle Aged, Risk Factors, Severity of Illness Index, Survival Analysis
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