Delayed Progression to Dialysis with Early and Intensive Management of Predialysis Chronic Kidney Disease: A Case-Based Approach

Abstract

In addition to hypertension and diabetes, disorders in mineral metabolism and bone disease (e.g. affecting phosphorus, calcium, parathyroid hormone, and vitamin D) are common complications of chronic kidney disease (CKD) and contribute to morbidity and mortality. Consequently, CKD requires multifactorial treatment to slow CKD progression and avoid end-stage renal disease. CKD progression and treatment outcomes are monitored by measuring the estimated glomerular filtration rate (eGFR), which decreases by 2-12 ml/min/1.73 m² per year depending on the stage of CKD and comorbidities, such as diabetes. This paper presents representative case studies illustrating the delay and reversal of CKD progression with comprehensive, individualized treatment regimens, including non-calcium phosphate binders, antihypertensives, lipid-lowering drugs, calcimimetics, and other drugs as required, to treat each component of CKD including CKD-mineral and bone disorder. Four patients are included, with an average age of 70-81 years and CKD stage 3 or 4 accompanied by various comorbidities, most notably diabetes and hypertension. The range of treatment and follow-up durations was 6-7 years. In each case, there was evidence of slowing or prevention of CKD progression, according to eGFR and serum creatinine, regardless of the patient's age or CKD stage. Despite a baseline eGFR of <20 ml/min/1.73 m² in 1 female patient, after 6 years of follow-up, her eGFR had stabilized and was maintained at >15 ml/min/1.73 m². These observations reinforce the value of early nephrology referral and comprehensive management of CKD and underlying conditions (hypertension and diabetes) beginning at eGFR <60 ml/min/1.73 m².

Evolution des patients en insuffisance rénale chronique stade V et facteurs prédictifs d’initiation de la dialyse

“…Dans notre étude, la moyenne du déclin annuel du DFG était de -3 ml/min/1,73m²/an, ce qui rejoint les données de la littérature (Reichel et al, 2020) ; (Stephen, 2013).…”

Entity of Stage 4 CKD over 75 Years Old is Different from that of Less than 75 Years of Age: Characteristics of Elderly Patients with Stage 4 CKD

“…Combining with these two factors, evaluation of renal function using eGFR formula will need some cautions. Second, several interventions [20] such as antihypertensive agents, especially the renin-angiotensin inhibitors [13], rHuEPO [14], phosphate binders [21] and so on, will decrease morbidity and mortality. These two major factors might relate to slower development to ESRD in the patients in elderly group.…”

End Stage Renal Disease

“…GFR<60ml/min/ m 2 ) delays the need for hemodialysis. 4 The CKD cases manifest various types of anemia; reported by Afshar et al in an Iranian study to be normochromic normocytic (80%), hypochromic microcytic (15%) and macrocytic (5%). 5 The hemodialysis procedure in the background of preexisting anemia bears an impact on hematological profile of the patients.…”