Supplementary Material for: Area Deprivation and Risk of Death and CKD Progression: Long-Term Cohort Study in Patients under Unrestricted Nephrology Care

<b><i>Background:</i></b> Area deprivation index (ADI) associates with prognosis in non-dialysis CKD. However, no study has evaluated this association in CKD patients under unrestricted nephrology care. <b><i>Methods:</i></b> We performed a long-term prospective study to assess the role of deprivation in CKD progression and mortality in stage 1–4 CKD patients under regular nephrology care, living in Naples (Italy). We used ADI calculated at census block levels, standardized to mean values of whole population in Naples, and linked to patients by georeference method. After 12 months of “goal-oriented” nephrology treatment, we compared the risk of death or composite renal outcomes (end-stage kidney disease or doubling of serum creatinine) in the tertiles of standardized ADI. Estimated glomerular filtration rate (eGFR) decline was evaluated by mixed effects model for repeated eGFR measurements. <b><i>Results:</i></b> We enrolled 715 consecutive patients (age: 64 ± 15 years; 59.1% males; eGFR: 49 ± 22 mL/min/1.73 m²). Most (75.2%) were at the lowest national ADI quintile. At referral, demographic, clinical, and therapeutic features were similar across ADI tertiles; after 12 months, treatment intensification allowed better control of hypertension, proteinuria, hypercholesterolaemia, and anaemia with no difference across ADI tertiles. During the subsequent long-term follow-up (10.5 years [interquartile range 8.2–12.6]), 166 renal events and 249 deaths were registered. ADI independently associated with all-cause death (<i>p</i> for trend = 0.020) and non-cardiovascular (CV) mortality (<i>p</i> for trend = 0.045), while CV mortality did not differ (<i>p</i> for trend = 0.252). Risk of composite renal outcomes was similar across ADI tertiles (<i>p</i> for trend = 0.467). The same held true for eGFR decline (<i>p</i> for trend = 0.675). <b><i>Conclusions:</i></b> In CKD patients under regular nephrology care, ADI is not associated with CKD progression, while it is associated with all-cause death due to an excess of non-CV mortality.背景：地区贫困指数（Area Deprivation Index, ADI）与非透析慢性肾脏病（Chronic Kidney Disease, CKD）患者的预后相关，但目前尚无研究针对接受无限制肾病专科诊疗的CKD患者，评估该指数与预后的关联。 方法：本研究为长期前瞻性研究，纳入意大利那不勒斯市接受常规肾病专科诊疗的1~4期CKD患者，旨在探讨贫困状况对CKD进展及死亡风险的影响。研究采用以普查街区为单位计算的地区贫困指数，以那不勒斯全市人口的均值作为标准化基准，并通过地理编码方法将指数与患者信息进行关联。在接受12个月的“目标导向型”肾病专科治疗后，本研究对比了按标准化ADI三分位分组的患者的死亡风险或复合肾脏结局（终末期肾病或血清肌酐翻倍）发生风险。针对多次检测的估算肾小球滤过率（Estimated Glomerular Filtration Rate, eGFR），本研究采用混合效应模型评估其下降速率。 结果：本研究共纳入715例连续性患者，年龄为64±15岁，男性占比59.1%，基线eGFR为49±22 mL/min/1.73m²。其中75.2%的患者处于全国ADI五分位的最低组。入组时，不同ADI三分位组患者的人口学、临床及治疗特征均无显著差异；经过12个月的治疗强化后，各组患者的高血压、蛋白尿、高胆固醇血症及贫血均得到更好控制，且组间无显著差异。在后续长达10.5年的随访期间（四分位间距8.2~12.6年），共记录到166例肾脏事件及249例死亡病例。ADI与全因死亡（趋势检验p=0.020）及非心血管（Cardiovascular, CV）死亡（趋势检验p=0.045）独立相关，而心血管死亡风险在各组间无显著差异（趋势检验p=0.252）。不同ADI三分位组的复合肾脏结局发生风险无显著差异（趋势检验p=0.467）。估算肾小球滤过率的下降速率同样未表现出组间差异（趋势检验p=0.675）。 结论：在接受常规肾病专科诊疗的CKD患者中，ADI与CKD进展无显著关联，但与非心血管死亡占比升高导致的全因死亡风险升高相关。