Skip Navigation


American Journal of Epidemiology Advance Access originally published online on June 17, 2009
American Journal of Epidemiology 2009 170(4):414-424; doi:10.1093/aje/kwp151
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
170/4/414    most recent
kwp151v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in Am. J. Epidemiol.
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (1)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Bash, L. D.
Right arrow Articles by Astor, B. C.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bash, L. D.
Right arrow Articles by Astor, B. C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Defining Incident Chronic Kidney Disease in the Research Setting

The ARIC Study

Lori D. Bash, Josef Coresh, Anna Köttgen, Rulan S. Parekh, Tibor Fulop, Yaping Wang and Brad C. Astor

Correspondence to Dr. Lori D. Bash, Welch Center for Prevention, Epidemiology, and Clinical Research, the Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-604, Baltimore, MD 21201 (e-mail: lbash{at}jhsph.edu).

Received for publication November 25, 2008. Accepted for publication March 13, 2009.

Deaths of participants and losses to follow-up pose challenges for defining outcomes in epidemiologic studies. The authors compared several definitions of incident chronic kidney disease (CKD) in terms of incidence, agreement, and risk factor associations. They used data from 14,873 participants in the community-based, multicenter, biracial Atherosclerosis Risk in Communities Study (1987–1999). The estimated glomerular filtration rate (eGFR) was based on serum creatinine at baseline and the 3- and 9-year follow-up visits. Hospitalizations were ascertained continuously. The authors compared 4 definitions of incident CKD: 1) low eGFR (<60 mL/minute/1.73 m2); 2) low and declining (≥25%) eGFR; 3) an increase in serum creatinine (≥0.4 mg/dL) at 3- or 9-year follow-ups; and 4) CKD-related hospitalization or death. From these definitions, they identified 1,086, 677, 457, and 163 cases, respectively. There was relatively good agreement among definitions 1–3, but definition 4 identified mostly different cases. Risk factor associations were consistent across definitions for hypertension and lipids. Diabetes showed weaker associations with definition 1 (incidence rate ratio = 1.5, 95% confidence interval: 1.2, 1.7) than with definition 4 (incidence rate ratio = 6.3, confidence interval: 4.4, 8.9). Associations with gender differed in direction and magnitude across definitions. Case definition can impact relative risk estimates for CKD risk factors.

cohort studies; diagnostic techniques and procedures; incidence; kidney diseases

Abbreviations: ARIC, Atherosclerosis Risk in Communities; CI, confidence interval; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision

Editor's note: An invited commentary on this article appears on page 425.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in Am. J. Epidemiol.:

Invited Commentary: Defining Incident Chronic Kidney Disease in Epidemiologic Study Settings
Stephen J. Tonna
Am. J. Epidemiol. 2009 170: 425-427. [Abstract] [Full Text]  





Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.