41
Chronic kidney disease progression in a large prevention
program in Colombia: A cohort study
Mauricio Sanabria
1
*, Diana Espinosa
2
, Luz A. Quintero
2
, Izcay Ronderos
3
, Jasmin Vesga
1
, Delia Perea
3
,
Nelcy Rodriguez
4
, Carlos J. Rincon
4
, Lina J. Herrera
4
, and Leyder Corzo
5
1
Baxter Renal Care Services Latinoamerica, Bogota;
2
Compensar EPS, Bogota;
3
Baxter Renal Care Services Colombia, Clinica de Salud Renal,
Bogota;
4
Pontificia Universidad Javeriana, Departamento de Epidemiologia y bioestadística, Facultad de medicina, Bogota;
5
Baxter Renal Care
Services Colombia, Instituto Nacional del Riñon, Bogota, Colombia
ORIGINAL ARTICLE
Abstract
Background: Estimating morbidity outcomes and the rate of progression of chronic kidney disease (CKD) patients is of great
importance for the health systems. Objective: The objective of this study is to estimate the incidence of dialysis initiation and
the rate of CKD progression in 2 years follow-up and identify factors associated with dialysis starts. Methods: A retrospec-
tive cohort study of adult with diagnosed CKD stages-G3, G4 (estimated glomerular filtration rate between 60 and
15 ml/min/1.73 m
2
) enrolled into a CKD prevention program in Bogotá-Colombia, since January 1, 2016, to June 30, 2017, with
follow-up until June 30, 2019. Cohort’s outcomes were arrival to dialysis and stage G5, dropout of the program, hospitalization,
and mortality. Repeated measurements of the estimation of glomerular filtration rate (eGFR) allowed us to estimate the change
over time in 4-month periods using a mixed-effects model. An Extended Cox model was adjusted for the time to start dialy-
sis. Results: One thousand four hundred forty-eight patients were included in the analysis; the incidence rate of dialysis
initiation was 2.1 events per 100 patients-year (95% CI: 1.5 2.7). The mean of eGFR variation was +1.1 ml/min/1.73 m
2
/year;
and for diabetics was −1.0 ml/min/m
2
/year. Being diabetic and having poorly controlled hypertension were significant risk
factors for time to dialysis initiation. Conclusion: The incidence rates of dialysis initiation, dropout, and hospitalization are
outcomes of significant interest in a CKD prevention program. Being diabetic and poor blood pressure control are risk factors
for a more rapid progression to dialysis.
Key words: Chronic kidney disease. Progression. Prevention. Predialysis. Kidney failure.
Programa de prevención de la progresión de la enfermedad renal crónica en
Colombia: un estudio de cohorte
Resumen
Antecedentes: Estimar los resultados de morbilidad y la tasa de progresión de los pacientes con enfermedad renal crónica
(ERC) es de gran importancia para los sistemas de salud. Objetivo: El objetivo de este estudio es estimar la incidencia de
inicio de diálisis y la velocidad de progresión de la ERC en dos años de seguimiento, e identificar factores asociados con
el inicio de diálisis. Métodos: Estudio de cohorte retrospectiva en adultos con diagnóstico de ERC estadios-G3, G4 (Tasa
de Filtración Glomerular estimada entre 60 y 15 ml/min/1.73 m
2
) inscritos en un programa de prevención de ERC en
Correspondence:
*Mauricio Sanabria
E-mail: mauricio_sanabria@baxter.com
Disponible en internet: 18-06-2021
Nefro Latinoam. 2021;18:41-49
www.nefrologialatinoamericana.com
Date of reception: 18-11-2020
Date of acceptance: 21-03-2021
DOI: 10.24875/NEFRO.20000055
Nefrología Latinoamericana
2444-9032/© 2021 Sociedad Latinoamericana de Nefrología e Hipertensión. Published by Permanyer. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).