Chronic kidney disease, a useful trigger for proactive primary care? Mortality results from a large U.K. cohort

Fam Pract. 2013 Jun;30(3):282-9. doi: 10.1093/fampra/cms079. Epub 2012 Dec 16.


Background: Much of the emphasis for primary care management of chronic kidney disease (CKD) has focused on cardiovascular risk; however, many patients die of other causes. Aim. In order to guide future primary care management of CKD, we report the causes of death from a large U.K. CKD cohort linked to health care administrative data.

Design, setting and methods: The Grampian Laboratory Outcomes Mortality and Morbidity Study (GLOMMS-1) is a community cohort of people with established CKD, identified in 2003 and followed up for 6 years. Causes of death were available from death certificates. The relative likelihood of different causes of death was compared to the general population.

Results: When standardized for age and sex, mortality was 4.7 (95% confidence interval 4.5-4.9) times higher in GLOMMS-1 than the general population. Non-cardiovascular diseases accounted for 1076 (50.9%) of deaths, 3.7 times more common than in the age- and sex-matched general population. For those with stages 3 and 4 CKD, without cardiovascular disease at baseline, a non-cardiovascular cause accounted for almost two-thirds of deaths. In those 75 years and older, dementia and falls were among the main non-cardiovascular causes of death.

Conclusions: Mortality in those with CKD is high, with non-cardiovascular diseases accounting for more than half of all deaths. While there is evidence that intervention may benefit those at risk of cardiovascular death, most of the non-cardiovascular causes of death identified were not readily amenable to prevention. A mechanism to identify which patients may benefit from intervention to prevent cardiovascular disease or renal disease progression is needed.

Keywords: Chronic disease; electronic medical records; medical co-morbidity; primary care; urology..

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Male
  • Middle Aged
  • Preventive Medicine
  • Primary Health Care*
  • Renal Insufficiency, Chronic / mortality*
  • United Kingdom / epidemiology