Risk factors for progression of advanced chronic kidney disease——A monocentric cohort study from a specific CKD outpatient management clinic / 中华肾脏病杂志

ABSTRACT

Objective To identify the risk factors for progression of advanced chronic kidney disease(CKD) patients who were cared by nephrologists in a specific CKD outpatient management clinic.Methods A prospective monocentric cohort study was performed.CKD patients of stage 3, 4 and 5 without renal replacement treatment were followed up regularly by nephrologists in this specific CKD management clinic.Patients with established atherosclerotic renal artery stenosis(ARAS) and chronic tubulointerstitial nephritis, and those who had not been followed-up for at least 12 months before Jun.30, 2010 were excluded.Clinical and laboratory data including blood pressure (BP), proteinuria, hemoglobulin (Hb), calcium phosphate product (Ca×P) and serum creatinine were consecutively collected.The treatment regimen was also recorded.Estimated glomerular filtration rate(eGFR) was calculated with the formula modified for Chinese to evaluate the change of renal function.The progression of kidney disease was defined as initiation of renal replacement therapy, the annual decrease of eGFR＞4 ml·min-1·(1.73 m2)-1, and/or death associated with renal disease.Results A total of 138 patients were enrolled in the final analysis with 84 patients of CKD stage 3, 36 of CKD stage 4 and 18 of CKD stage 5, respectively.At the time of enrollment, patients had an average age of (56.5±16.7) years old with an average eGFR of (32.3±13.4) ml·min-1·(1.73 m2)-1.During a mean follow-up interval of (27.1±12.1) months, the patients were well-controlled with an average blood pressure of (126.5±12.4)/(76.4±7.9) mm Hg in 50.7％(70/138), less than or equal to 130/80 mm Hg, an average Hb of(123.8±17.1) g/L in 73.9％(102/138), above or equal to 110 g/L and an average Ca×P of (45.2±7.7) mg2/dl2 in 89.1％(123/138), less than or equal to 55 mg2/dl2.Sixty-two patients (44.9％) had progression of kidney disease. On univariate analysis, factors predicting progression were low eGFR at referral, high systolic pressure, low Hb level, high Ca×P and proteinuria during follow-up, and renin-angiotensin system inhibitors treatment did not affect the progression.After the adjustment, multivariate analysis revealed proteinuria and low Hb level were independent factors for the progression of kidney disease.Conclusions The co-morbidities of advanced CKD patients can be managed efficiently in specific CKD outpatient management clinic.Control of proteinuria and correction of anemia may be beneficial to prevent the progression of advanced CKD.