Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure - PubMed (original) (raw)

Review

. 2014 May 24;383(9931):1831-43.

doi: 10.1016/S0140-6736(14)60384-6.

Adrian Covic [ 2](#full-view-affiliation-2 "PaArhon University Hospital, "Grigore T Popa" University of Medicine and Pharmacy, Iasi, Romania."), Danilo Fliser 3, Denis Fouque 4, David Goldsmith 5, Mehmet Kanbay 6, Francesca Mallamaci [ 7](#full-view-affiliation-7 "Nephrology, Hypertension, and Renal Transplantation Unit, Ospedali Riuniti and CNR-IFC "Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension", Reggio Calabria, Italy."), Ziad A Massy 8, Patrick Rossignol 9, Raymond Vanholder 10, Andrzej Wiecek 11, Carmine Zoccali [ 7](#full-view-affiliation-7 "Nephrology, Hypertension, and Renal Transplantation Unit, Ospedali Riuniti and CNR-IFC "Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension", Reggio Calabria, Italy."), Gérard M London 12; Board of the EURECA-m Working Group of ERA-EDTA

Affiliations

Review

Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure

Alberto Ortiz et al. Lancet. 2014.

Abstract

Patients with chronic kidney failure--defined as a glomerular filtration rate persistently below 15 mL/min per 1·73 m(2)--have an unacceptably high mortality rate. In developing countries, mortality results primarily from an absence of access to renal replacement therapy. Additionally, cardiovascular and non-cardiovascular mortality are several times higher in patients on dialysis or post-renal transplantation than in the general population. Mortality of patients on renal replacement therapy is affected by a combination of socioeconomic factors, pre-existing medical disorders, renal replacement treatment modalities, and kidney failure itself. Characterisation of the key pathophysiological contributors to increased mortality and cardiorenal risk staging systems are needed for the rational design of clinical trials aimed at decreasing mortality. Policy changes to improve access to renal replacement therapy should be combined with research into low-cost renal replacement therapy and optimum clinical care, which should include multifaceted approaches simultaneously targeting several of the putative contributors to increased mortality.

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