1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
3Cancer Research Institute, Seoul National University, Seoul, Korea
4Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
5Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
6Department of Internal Medicine, National Medical Center, Seoul, Korea
Copyright © 2022 The Korean Society for Preventive Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
The authors have no conflicts of interest associated with the material presented in this paper.
FUNDING
This study was supported by the Research Program funded by the Korean Disease Control and Prevention Agency (KDCA) (2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, and 2019E320100).
AUTHOR CONTRIBUTION
Conceptualization: Oh KH, Park SK, Kim J, Ahn C. Data curation: Oh KH, Kim J. Formal analysis: Oh KH, Kim J. Funding acquisition: Ahn C, Oh KH. Methodology: Park SK. Project administration: Oh KH. Visualization: Oh KH, Kim J. Writing – original draft: Oh KH. Writing – review & editing: Oh KH, Kim J, Park SK, Ahn C.
Variables | Total CKD patients | Diabetic CKD patients | Non-diabetic CKD patients | p-value3 | ||||||
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Event no. | Incidence rates | Standardized incidence rates2 | Event no. | Incidence rates | Standardized incidence rates | Event no. | Incidence rates | Standardized incidence rates | ||
ESKD | 635 | 54.2 | 47.4 | 307 | 94.0 | 119.3 | 328 | 39.0 | 36.4 | <0.001 |
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ESKD or eGFR halving | 830 | 75.0 | 67.7 | 364 | 119.7 | 155.2 | 466 | 58.2 | 55.3 | <0.001 |
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eGFR halving | 579 | 48.0 | 46.0 | 230 | 64.1 | 86.7 | 349 | 41.4 | 39.9 | <0.001 |
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3-point MACE | 91 | 6.7 | 4.0 | 54 | 12.8 | 8.3 | 37 | 4.0 | 2.5 | <0.001 |
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4-point MACE | 115 | 8.5 | 4.9 | 68 | 16.3 | 9.8 | 47 | 5.0 | 3.2 | <0.001 |
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Myocardial infarction | 20 | 1.5 | 0.8 | 13 | 3.0 | 1.1 | 7 | 0.7 | 0.5 | 0.003 |
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Unstable angina | 29 | 2.1 | 1.0 | 17 | 4.0 | 1.7 | 12 | 1.3 | 0.8 | 0.003 |
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Congestive heart failure | 14 | 1.0 | 0.5 | 8 | 1.9 | 0.7 | 6 | 0.6 | 0.4 | 0.048 |
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Ischemic stroke | 33 | 2.4 | 1.3 | 20 | 4.7 | 2.9 | 13 | 1.4 | 0.8 | 0.001 |
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Hemorrhagic stoke | 14 | 1.0 | 0.6 | 5 | 1.2 | 0.4 | 9 | 1.0 | 0.6 | 0.733 |
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Any death | 157 | 11.4 | 7.0 | 89 | 20.5 | 10.7 | 68 | 7.2 | 5.2 | <0.001 |
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All composite outcomes | 992 | 93.6 | 78.9 | 439 | 156.6 | 173.2 | 552 | 70.9 | 64.3 | <0.001 |
KNOW-CKD, KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease; CKD, chronic kidney disease; ESKD, end-stage kidney disease; eGFR, estimated glomerular filtration rate; MACE, major adverse cardiovascular events; 3-point MACE, fatal cardiac events+acute myocardial infarction+stroke (ischemic, hemorrhagic); 4-point MACE, fatal cardiac events+acute myocardial infarction+stroke (ischemic, hemorrhagic)+unstable angina.
1 Median follow-up 6.15 years (range, 0.00 to 9.49).
2 Standardized to the Korean population as of 2005.
3 From Poisson regression model in the incidence comparisons between event rates in diabetic CKD patients and non-diabetic CKD patients.
Demographic factors | Total (n=1071) | Stage | p-value | |||
---|---|---|---|---|---|---|
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G3a (n=332) | G3b (n=479) | G4 (n=260) | ||||
Age (y) | Mean±SD | 66.0±8.2 | 65.5±8.0 | 66.9±8.1 | 64.9±8.3 | 0.0011 |
Med [Min-Max] | 67 [45–79] | 66 [45–79] | 68 [46–79] | 65 [45–79] | ||
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Sex | Male | 749 (69.9) | 257 (77.4) | 328 (68.5) | 164 (63.1) | 0.0012 |
Female | 322 (30.1) | 75 (22.6) | 151 (31.5) | 96 (36.9) | ||
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Diabetes | Yes | 665 (62.1) | 181 (54.5) | 312 (65.1) | 172 (66.2) | 0.0032 |
No | 406 (37.9) | 151 (45.5) | 167 (34.9) | 88 (33.8) |
Variables | Total CKD patients | Diabetic CKD patients | Non-diabetic CKD patients | p-value | ||||||
---|---|---|---|---|---|---|---|---|---|---|
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Event no. | Incidence rates | Standardized incidence rates |
Event no. | Incidence rates | Standardized incidence rates | Event no. | Incidence rates | Standardized incidence rates | ||
ESKD | 635 | 54.2 | 47.4 | 307 | 94.0 | 119.3 | 328 | 39.0 | 36.4 | <0.001 |
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ESKD or eGFR halving | 830 | 75.0 | 67.7 | 364 | 119.7 | 155.2 | 466 | 58.2 | 55.3 | <0.001 |
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eGFR halving | 579 | 48.0 | 46.0 | 230 | 64.1 | 86.7 | 349 | 41.4 | 39.9 | <0.001 |
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3-point MACE | 91 | 6.7 | 4.0 | 54 | 12.8 | 8.3 | 37 | 4.0 | 2.5 | <0.001 |
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4-point MACE | 115 | 8.5 | 4.9 | 68 | 16.3 | 9.8 | 47 | 5.0 | 3.2 | <0.001 |
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Myocardial infarction | 20 | 1.5 | 0.8 | 13 | 3.0 | 1.1 | 7 | 0.7 | 0.5 | 0.003 |
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Unstable angina | 29 | 2.1 | 1.0 | 17 | 4.0 | 1.7 | 12 | 1.3 | 0.8 | 0.003 |
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Congestive heart failure | 14 | 1.0 | 0.5 | 8 | 1.9 | 0.7 | 6 | 0.6 | 0.4 | 0.048 |
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Ischemic stroke | 33 | 2.4 | 1.3 | 20 | 4.7 | 2.9 | 13 | 1.4 | 0.8 | 0.001 |
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Hemorrhagic stoke | 14 | 1.0 | 0.6 | 5 | 1.2 | 0.4 | 9 | 1.0 | 0.6 | 0.733 |
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Any death | 157 | 11.4 | 7.0 | 89 | 20.5 | 10.7 | 68 | 7.2 | 5.2 | <0.001 |
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All composite outcomes | 992 | 93.6 | 78.9 | 439 | 156.6 | 173.2 | 552 | 70.9 | 64.3 | <0.001 |
Variables | Phase I | Phase II |
---|---|---|
Recruitment period (year) | 2011–2016 | 2019–2022 |
Study subjects (n) | 2238 (actual) | 1500 (target) |
Age (y) | 20–75 | 40–79 |
CKD stage or eGFR range | CKD stages G1–G5 (non-dialysis dependent) | 15–60 mL/min/1.73m2 |
Diabetes (%) | 34 | 50 (target) |
Major study objectives | Investigate the clinical course of CKD about the major events such as ESKD, CV events, and death Elucidate the major risk factors of adverse outcomes Compare the course of the 4 major etiologic diseases of CKD |
Particularly focus on high-risk CKD subjects such as those with diabetic nephropathy, hypertensive nephropathy, old age, and low eGFR Collect detailed information on the nutritional status, dietary habits and cognitive functions from CKD subjects |
Follow-up duration (y) | ~20 | ~10 |
Demographic factors | Total (n=1071) | Stage | p-value | |||
---|---|---|---|---|---|---|
| ||||||
G3a (n=332) | G3b (n=479) | G4 (n=260) | ||||
Age (y) | Mean±SD | 66.0±8.2 | 65.5±8.0 | 66.9±8.1 | 64.9±8.3 | 0.001 |
Med [Min-Max] | 67 [45–79] | 66 [45–79] | 68 [46–79] | 65 [45–79] | ||
| ||||||
Sex | Male | 749 (69.9) | 257 (77.4) | 328 (68.5) | 164 (63.1) | 0.001 |
Female | 322 (30.1) | 75 (22.6) | 151 (31.5) | 96 (36.9) | ||
| ||||||
Diabetes | Yes | 665 (62.1) | 181 (54.5) | 312 (65.1) | 172 (66.2) | 0.003 |
No | 406 (37.9) | 151 (45.5) | 167 (34.9) | 88 (33.8) |
KNOW-CKD, KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease; CKD, chronic kidney disease; ESKD, end-stage kidney disease; eGFR, estimated glomerular filtration rate; MACE, major adverse cardiovascular events; 3-point MACE, fatal cardiac events+acute myocardial infarction+stroke (ischemic, hemorrhagic); 4-point MACE, fatal cardiac events+acute myocardial infarction+stroke (ischemic, hemorrhagic)+unstable angina. Median follow-up 6.15 years (range, 0.00 to 9.49). Standardized to the Korean population as of 2005. From Poisson regression model in the incidence comparisons between event rates in diabetic CKD patients and non-diabetic CKD patients.
KNOW-CKD, KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; CV, cardiovascular.
Values are presented as number (%). KNOW-CKD, KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease; SD, standard deviation; Med, median; Min, minimum; Max, maximum. Kruskal-Wallis test. Chi-square test.