Effects of a nation-wild CKD prevention program on reducing risks of mortality: A population-based cohort study in Taiwan

It was known that chronic kidney disease (CKD) prevention plan may be able to preserve CKD patients' renal function through better blood pressure, glucose and anemia control. Yet, few data demonstrated the effectiveness of a national-wild CKD prevention plan on mortality or development of long-term dialysis in CKD patients.

In Taiwan, the National Health Insurance (NHI) Administration implemented a nation-wide CKD prevention program since 2007, recruiting the CKD patients later than stage 3B for close monitoring and health education. For this study, we selected 27,875 study subjects as the cases, who participated in this CKD prevention program from 2007 to 2011. For the control group, we selected 124,913 CKD stage compatible subjects, who took part in a nation-wide health screening program in 2007-2011 but not recruited in the aforementioned CKD prevention program. All subjects were followed for more than 12 months, until the end of 2012.

In a median follow-up time of 48 months, the mortality rate and incidence of long-term dialysis for the case and control group was 9.7 vs. 41.9 and 35.0 vs. 7.1 per 1000 person-years, respectively. In Cox's proportional hazard model, after adjusting age, gender, hypertension, diabetes, CKD stage, systolic blood pressure, diastolic blood pressure, lower albumin, anemia, hospital level and geographical location, the hazards of mortality and long-term dialysis were 0.17 (95%CI: 0.16-0.19, P < .001) and 1.21 (95%CI:  1.12-1.30, P < .001), compared the case to the control group, respectively.

We conclude that the CKD prevention plan could effectively prevent mortality. The increased risk of developing long-term dialysis for the case group, which may be due to the effects of competing risk, warrants for further research.