Impact of chronic kidney disease on mortality: A nationwide cohort study
Kyeong Min Kim1,2,* , Hyung Jung Oh1,3,* , Hyung Yun Choi1,4 , Hajeong Lee1,5 , Dong-Ryeol Ryu1,6
1ESRD Registry Committee, Korean Society of Nephrology, Seoul, Korea
2Department of Internal Medicine, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea
3Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
4The Korean Society of Nephrology, Seoul, Korea
5Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
6Department of Internal Medicine and Tissue Injury Defense Research Center, College of Medicine, Ewha Womans University, Seoul, Korea
Correspondence to: Dong-Ryeol Ryu
Department of Internal Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. E-mail: drryu@ewha.ac.kr

Edited by Sangho Lee, Kyung Hee University, Seoul, Korea

*Kyeong Min Kim and Hyung Jung Oh contributed equally to this study.
Received: October 19, 2018; Revised: May 19, 2019; Accepted: June 19, 2019; Published online: August 6, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Mortality is higher in patients with chronic kidney disease (CKD) than in the general population, but little information is available on CKD-related mortality that is representative of the Korean population. Our objective was to investigate mortality risk in Korean patients with CKD.
Methods: We identified patients with incident CKD who had not undergone dialysis or kidney transplantation between January 1, 2003 and December 31, 2007 in Korea using the database of the Korean National Health Insurance Service-National Sample Cohort, and stratified the population into the following three groups: group 1 (n = 1,473), controls; group 2 (n = 2,212), patients with diabetes or hypertension, but without CKD; and group 3 (n = 2,212), patients with CKD. We then monitored them for all-cause mortality until December 2013.
Results: A total of 1,473 patients were included in this analysis. During the follow-up period, 941 patients in group 3 died (134 deaths/1,000 person-years) compared with 550 deaths in the group 2 (34 deaths/1,000 person-years) and 459 deaths in group 1 (30 deaths/1,000 person-years). The rate ratio for mortality rate was 4.5, and the hazard ratio for mortality was 4.88 (95% confidence interval [CI], 4.36-5.47, P < 0.001) in patients in group 3 compared with age- and sex-matched controls (group 1). The rate ratio for mortality rate was 4.0, and the hazard ratio for mortality was 4.36 (95% CI, 3.92-4.85, P < 0.001) in patients in group 3 compared with patients in group 2.
Conclusion: In this nationally representative sample cohort, excess mortality was observed in Korean patients with incident CKD.
Keywords: Diabetes mellitus, Hypertension, Korea, Mortality, Renal insufficiency, chronic


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