Unexpected Factors Could Significantly Influence CKD Progression

Factors beyond those normally expected to cause chronic kidney disease (CKD) progression could significantly influence the rate of renal functional decline in CKD patients at later stages, according to the results of a recent study.

“Until recent years, it was thought that CKD exhibited a predominantly linear progression pattern, with a more rapid decline of renal function at later stages…However, recent observational studies have shown that patterns of CKD progression may be highly heterogeneous…” the researchers wrote.
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They conducted a retrospective observational study of a cohort of 915 adults with CKD stage 4 or 5 who were not on dialysis. Renal function decline was estimated as the slope of the individual linear regression line of estimated glomerular filtration rate (eGFR) over time.

Overall, a linear pattern was observed in 38% of the participants, while 23% experienced an unidentifiable pattern, 24% experienced a nonlinear pattern (curvilinear), and 15% experienced positive pattern (improvement of renal function).

The mean eGFR slope was −3.35 ± 4.45 mL/min/year, and linear and unidentifiable patterns were associated with more rapid loss of renal function.

Using multiple linear and logistic regression analysis, the researchers found that the magnitude of proteinuria, the systolic blood pressure, and treatment with dual renin-angiotensin system blockade were associated with more rapid CKD progression, while older age and discontinuation of commonly prescribed medications with the potential to influence renal function of eGFR were associated with slower CKD progress.

“In conclusion, this study shows that, in addition to highly expected risk factors for CKD progression (age, sex, arterial hypertension, proteinuria), other potential modifiable factors, mainly related to the adverse effects of commonly prescribed medication, may influence significantly the rate of renal function decline of CKD patients at later stages. Interactions among these factors result in different patterns of progression, the identification of which may be useful for optimizing the care of patients with advanced CKD,” the researchers wrote.

—Michael Potts

Reference:

Caravaca-Fontan F, Azevedo L, Luna E, Caravaca F. Patterns of progression of chronic kidney disease at later stages. Clinical Kidney Journal. 2018;11(2):246–253.