Interactive exploration of adverse events and multimorbidity in CKD
Authors: Steinbrenner Inga , Kotsis Fruzsina , Kosch Robin , Meiselbach Heike , Bärthlein Barbara , Stockmann Helena , Lipovsek Jan , Zacharias Helena U , Altenbuchinger Michael , Dienemann Thomas , Wytopil Monika , Bächle Helena , Sommerer Claudia , Titze Stephanie , Weigel Anke , Weissensteiner Hansi , Schönherr Sebastian , Forer Lukas , Kurz Nadine S , Menne Jan , Schlieper Georg , Schneider Markus P , Schaeffner Elke , Kielstein Jan T , Sitter Thomas , Floege Jürgen , Wanner Christoph , Kronenberg Florian , Köttgen Anna , Busch Martin , Krane Vera , Schmid Matthias , Eckardt Kai-Uwe , Schultheiss Ulla T ,   the GCKD Investigators, Eckardt Kai-Uwe , Meiselbach Heike , Schneider Markus P , Schiffer Mario , Prokosch Hans-Ulrich , Bärthlein Barbara , Beck Andreas , Reis André , Ekici Arif B , Becker Susanne , Alberth-Schmidt Ulrike , Weigel Anke , Marschall Sabine , Schefler Eugenia , Walz Gerd , Köttgen Anna , Schultheiß Ulla T , Kotsis Fruzsina , Meder Simone , Mitsch Erna , Reinhard Ursula , Floege Jürgen , Saritas Turgay , Groß Alice , Schaeffner Elke , Baid-Agrawal Seema , Theisen Kerstin , Schmidt-Ott Kai , Zeier Martin , Sommerer Claudia , Aykac Mehtap , Wolf Gunter , Busch Martin , Steiner Andy , Sitter Thomas , Wanner Christoph , Krane Vera , Börner-Klein Antje , Bauer Britta , Kronenberg Florian , Raschenberger Julia , Kollerits Barbara , Forer Lukas , Schönherr Sebastian , Weissensteiner Hansi , Oefner Peter , Gronwald Wolfram , Schmid Matthias , Nadal Jennifer 
Published: April 2024

ABSTRACT

Background
Persons with chronic kidney disease (CKD) are at increased risk of adverse events, early mortality and multimorbidity. A detailed overview of adverse event types and rates from a large CKD cohort under regular nephrological care is missing. We generated an interactive tool to enable exploration of adverse events and their combinations in the prospective, observational German CKD (GCKD) study.

Methods
The GCKD study enrolled 5217 participants under regular nephrological care with an estimated glomerular filtration rate of 30–60 or &gt;60 mL/min/1.73 m2 and an overt proteinuria. Cardiovascular, cerebrovascular and peripheral vascular, kidney, infection, and cancer events, as well as deaths were adjudicated following a standard operation procedure. We summarized these time-to-event data points for exploration in interactive graphs within an R shiny app. Multivariable adjusted Cox models for time to first event were fitted. Cumulative incidence functions, Kaplan–Meier curves and intersection plots were used to display main adverse events and their combinations by sex and CKD etiology.

Results
Over a median of 6.5 years, 10 271 events occurred in 2947 participants (56.5%), of which 680 participants (13.0%) died. The new publicly available interactive platform enables readers to scrutinize adverse events and their combinations as well as mortality trends as a gateway to better understand multimorbidity in CKD: incident rates per 1000 patient-years varied by event type, CKD etiology and baseline characteristics. Incidence rates for the most frequent events and their recurrence were 113.6 (cardiovascular), 75.0 (kidney) and 66.0 (infection). Participants with presumed diabetic kidney disease and men were more prone to experiencing events.

Conclusion
This comprehensive explorative tool to visualize adverse events (https://www.gckd.org/studienhintergrund/previous-study-results/event-analysis/), their combination, mortality and multimorbidity among persons with CKD may serve as a valuable resourec for patient care, identification of high-risk groups, health services and public health policy planning.