Factors affecting the progression of chronic kidney disease

Year 2023, Volume: 4 Issue: 3, 207 - 210, 28.06.2023

Raziye Yazıcı , İbrahim Güney

https://doi.org/10.47582/jompac.1277537

Abstract

Aims: Chronic kidney disease (CKD) is characterized by irreversible and progressive loss of renal function. One of the most important goals in CKD management is to delay CKD progression. The aim of this study was to investigate the outcomes of non-dialysing CKD patients, rate of progression of disease and factors associated with CKD progression and mortality.
Methods: In this retrospective study, 245 non-dialysis CKD (stage 3-5) patients who presented to nephrology outpatient clinic between December 2013 and June 2015 were included. Patients’ baseline demographic, clinical/laboratory data were obtained. Outcomes of the patients in terms of CKD progression (defined as the initiation of renal replacement therapy or death) between November 2022 and December 2022 were recorded.
Results: Patients’ mean age (baseline) was 56±12 years; 116 patients (47.3%) were female. During median 46 months of follow-up period, 42.9% of the patients underwent renal replacement therapy and all-cause mortality rate was 9.8%. Baseline eGFR, proteinuria and having diabetes mellitus as a comorbidity were found to be associated with CKD progression, independently (the risk increases by 75% with each 1 ml/min decrease in eGFR, p<0.001; the risk increases approximately 1.8 times with each 1 gr/day increase in proteinuria, p=0.003; the risk increases approximately 3 times with diabetes mellitus, p=0.043).
Conclusion: Our findings showed that baseline eGFR level, having diabetes mellitus and baseline proteinuria values were independent risk factors associated with disease progression and mortality in non-dialysing CKD patients. Early diagnosis and close monitoring of CKD, applying interventions targeting risk factors associated with CKD progression should be considered to delay CKD progression.

Keywords

Chronic kidney disease, progression, renal replacement therapy, risk factors

Kronik böbrek hastalığı progresyonunu etkileyen faktörler

Abstract

Amaç: Kronik böbrek hastalığı (KBH), böbrek fonksiyonunun geri dönüşümsüz ve ilerleyici kaybı ile karakterizedir. KBH yönetiminde en önemli hedeflerden biri KBH ilerlemesini geciktirmektir. Bu çalışmanın amacı, diyalize girmeyen KBH hastalarının sonuçlarını, hastalığın ilerleme hızını ve KBH ilerlemesi ve mortalitesi ile ilişkili faktörleri araştırmaktı. Gereç ve Yöntem: Bu retrospektif çalışmaya Aralık 2013 ile Haziran 2015 tarihleri arasında nefroloji polikliniğine başvuran diyalize girmeyen 245 KBH hastası (evre 3-5) dahil edildi. Hastaların başlangıç demografik, klinik/laboratuvar verileri elde edildi. Hastaların Kasım 2022 ve Aralık 2022 tarihleri arasında KBH progresyonu (renal replasman tedavisine başlanması veya ölüm olarak tanımlanan) açısından sonuçları kaydedildi.
Bulgular: Hastaların ortalama yaşı (başlangıçta) 56±12 idi; 116 hasta (%47,3) kadındı. Medyan 46 aylık takipte hastaların %42,9'una renal replasman tedavisi uygulandı ve tüm nedenlere bağlı ölüm oranı %9,8 idi. Başlangıçtaki eGFR, proteinüri ve komorbidite olarak diabetes mellitus KBH progresyonu ile bağımsız olarak ilişkili bulundu (eGFR'de her 1 ml/dk düşüşle risk %75 artmakta, p<0,001; proteinüride her 1 gr/gün artışla risk yaklaşık 1,8 kat artmakta, p=0,003; ve diabetes mellitus varlığı ile risk yaklaşık 3 kat artmakta, p=0,043).
Sonuç: Bulgularımız, diyalize girmeyen KBH hastalarında başlangıç eGFR düzeyi, diabetes mellitus varlığı ve başlangıç proteinüri değerlerinin hastalık progresyonu ve mortalite ile ilişkili bağımsız risk faktörleri olduğunu gösterdi. KBH progresyonunu geciktirmek için, KBH'nin erken teşhisi ve yakından izlemi, KBH progresyonu ile ilişkili risk faktörlerini hedefleyen girişimlerin uygulanması düşünülmelidir.

Keywords

Kronik böbrek hastalığı, progresyon, renal replasman tedavisi, risk faktörleri

References

• Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One. 2016;11:e0158765. doi:10.1371/journal.pone.0158765
• Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389:1238-1252. doi:10.1016/S0140-6736 (16)32064-5
• Ruiz-Ortega M, Rayego-Mateos S, Lamas S, Ortiz A, Rodrigues-Diez RR. Targeting the progression of chronic kidney disease. Nat Rev Nephrol. 2020;16:269-288. doi:10.1038/s41581-019-0248-y
• Grams ME, Yang W, Rebholz CM, et al.; CRIC Study Investigators. Risks of adverse events in advanced CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2017;70:337-346. doi:10.1053/j.ajkd.2017.01.050
• Habas E Sr, Habas E, Khan FY, et al. Blood pressure and chronic kidney disease progression: an updated review. Cureus. 2022;14:e24244. doi:10.7759/cureus.24244
• Davis E, Campbell K, Gobe G, Hawley C, Isbel N, Johnson DW. Association of anthropometric measures with kidney disease progression and mortality: a retrospective cohort study of pre-dialysis chronic kidney disease patients referred to a specialist renal service. BMC Nephrol. 2016;17:74. doi:10.1186/s12882-016-0290-y
• Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461-470. doi:10.7326/0003-4819-130-6-199903160-00002
• Levin A, Stevens PE, Bilous RW, et al. Kidney disease: improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150. doi:10.1038/kisup.2012.73
• Landray MJ, Emberson JR, Blackwell L, et al. Prediction of ESRD and death among people with CKD: the Chronic Renal Impairment in Birmingham (CRIB) prospective cohort study. Am J Kidney Dis. 2010;56:1082-1094. doi:10.1053/j.ajkd.2010.07.016
• Zhang X, Fang Y, Zou Z, et al. Risk factors for progression of CKD with and without diabetes. J Diabetes Res. 2022;2022:9613062. doi:10.1155/2022/9613062
• Swartling O, Rydell H, Stendahl M, Segelmark M, Trolle Lagerros Y, Evans M. CKD progression and mortality among men and women: a nationwide study in Sweden. Am J Kidney Dis. 2021;78:190-99.e1. doi:10.1053/j.ajkd.2020.11.026
• Grams ME, Surapaneni A, Appel LJ, et al.; CRIC Study Investigators. Clinical events and patient-reported outcome measures during CKD progression: findings from the chronic renal insufficiency cohort study. Nephrol Dial Transplant. 2021;36:1685-93. doi:10.1093/ndt/gfaa364
• Hoefield RA, Kalra PA, Baker P, et al. Factors associated with kidney disease progression and mortality in a referred CKD population. Am J Kidney Dis. 2010;56:1072-81. doi:10.1053/j.ajkd. 2010.06.010
• Go AS, Yang J, Tan TC, et al. Kaiser Permanente Northern California CKD Outcomes Study. Contemporary rates and predictors of fast progression of chronic kidney disease in adults with and without diabetes mellitus. BMC Nephrol. 2018;19:146. doi:10.1186/s12882-018-0942-1