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Master thesis

Progression de l'insuffisance rénale chronique, une étude de cohorte française en population générale

Abstract : Background: Progression of chronic kidney disease (CKD) can be inhibited bymeasures of nephroprotection yet this progression is poorly identified in the generalpopulation. The purpose of our study was to investigate disease progression in CKDpatients identified in the general population.Methods: The inclusion criteria in the EPIRAN study were: two serum creatinine assays >150 ?mol/l at a 3-month interval, CKD discovered from 01/01/2004 to 06/30/2006, residence in Nancy. For the purpose of the progression study, only patients with at least 3 creatinine assays were selected. Three definitions of progression were used: two-fold increase in creatinine (D1), 30% decline in GFR (MDRD formula) (D2) and 50% decline in GFR (D3), or onset of dialysis for all 3 definitions. The endpoint was 06/30/2008. Time to event was determined from diagnosis of CKD to progression or endpoint. A Cox model was created for each definition.Results: Among the 631 patients included in the EPIRAN study, 573 had at least 3creatinine assays. At diagnosis of CKD serum creatinine was 189 ± 127.9 ?mol/l andMDRD 32 ml/min/1,73m². During follow-up between 2 and 4 years 22% of patients were progressors according to D1, 48% according to D2 and 26% according to D3. 37% of patients were referred to nephrologists after the diagnosis of CKD. Factors associated with progression were: for D1, referral to nephrologists (HR=2.56) and baseline hemoglobin (HR=0.89), for D2 age<65 years (HR=1.83) and baseline hemoglobin (HR=0.9) and for D3 age<65 years (RR=1.89), referral to nephrologists (HR=1.93) and presence of neoplasia (HR=1.90).Conclusions: Primary care physicians refer to the nephrologists patients with thegreatest risk of progression. It is necessary to optimize coordination of care to limitdisease progression and reduce mortality of those patients.
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Emilie Girardot. Progression de l'insuffisance rénale chronique, une étude de cohorte française en population générale. Sciences du Vivant [q-bio]. 2010. ⟨hal-01732860⟩

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