Independent Role of Underlying Kidney Disease on Renal Prognosis of Patients with Chronic Kidney Disease under Nephrology Care

Abstract

Primary kidney disease is suggested to affect renal prognosis of CKD patients; however, whether nephrology care modifies this association is unknown. We studied patients with CKD stage I-IV treated in a renal clinic and with established diagnosis of CKD cause to evaluate whether the risk of renal event (composite of end-stage renal disease and eGFR decline ≥40%) linked to the specific diagnosis is modified by the achievement or maintenance in the first year of nephrology care of therapeutic goals for hypertension (BP ≤130/80 mmHg in patients with proteinuria ≥150 mg/24h and/or diabetes and ≤140/90 in those with proteinuria <150 mg/24h and without diabetes) anemia (hemoglobin, Hb ≥11 g/dL), and proteinuria (≤0.5 g/24h). Survival analysis started after first year of nephrology care. We studied 729 patients (age 64±15 y; males 59.1%; diabetes 34.7%; cardiovascular disease (CVD) 44.9%; hypertensive nephropathy, HTN 53.8%; glomerulonephritis, GN 17.3%; diabetic nephropathy, DN 15.9%; tubule-interstitial nephropathy, TIN 9.5%; polycystic kidney disease, PKD 3.6%). During first year of Nephrology care, therapy was overall intensified in most patients and prevalence of main therapeutic goals generally improved. During subsequent follow up (median 3.3 years, IQR 1.9-5.1), 163 renal events occurred. Cox analysis disclosed a higher risk for PKD (Hazard Ratio 5.46, 95% Confidence Intervals 2.28–10.6) and DN (1.28,2.99–3.05), versus HTN (reference), independently of age, gender, CVD, BMI, eGFR or CKD stage, use of RAS inhibitors and achievement or maintenance in the first year of nephrology care of each of the three main therapeutic goals. No interaction was found on the risk of CKD progression between diagnostic categories and month-12 eGFR (P=0.737), as with control of BP (P=0.374), Hb (P=0.248) or proteinuria (P=0.590). Therefore, in CKD patients under nephrology care, diagnosis of kidney disease should be considered in conjunction with the main risk factors to refine renal risk stratification.

Sex Differences in the Progression of CKD Among Older Patients: Pooled Analysis of 4 Cohort Studies

“…This is a pooled analysis of 4 prospective cohort studies carried out in 40 nephrology clinics in Italy ( Fig S1; Item S1). [13][14][15][16] A detailed description of the cohorts is reported in Item S2. Although the primary aim of these studies was different, the 4 cohorts shared similar inclusion/exclusion criteria.…”

Competing-Risk Analysis of Death and ESKD by Hyperkalemia Status in Non-Dialysis CKD Patients Receiving Stable Nephrology Care

“…In this setting, improving risk stratification is mandatory to optimize practice of nephrology workforce, which is limited today and projected to further shrink in the next future [39]. Second, at variance with unreferred CKD, where death overcomes ESKD, the natural fate of CKD under nephrology care is progression to ESKD [25][26][27][28][35][36][37][38][40][41][42]; in this regard, it is important to note that a recent survey among European nephrologists has disclosed that in CKD stage 5 the main driver to start renal substitutive therapy is the clinical picture, as currently recommended by international guidelines [18,43], with refractory hyperkalemia eliciting immediate dialysis start by 100% of interviewed nephrologists [44]. Third, hyperkalemia is expected to be prevalent in this setting because nephrologists manage advanced CKD and, moreover, prescribe anti-RAS agents to prevent CKD progression [1][2][3][4][5][6][7][16][17][18][19][20][21].…”

“…Cohorts included ND-CKD patients (eGFR <60 mL/min/1.73m 2 or proteinuria >0.15 g/24h) under stable care in Italian outpatients nephrology clinics to gain information on clinical features and outcome of referred CKD. Methodological details are described in the published papers [25,[27][28][29], and here summarized in Appendix. To the aims of this study, we excluded duplicate patients, those with missing sK level as patients with only referral visit.…”

Less contribution of mast cells to the progression of renal fibrosis in Rat kidneys with chronic renal failure

“…Among them, the rat model with subtotal nephrectomy (5/6 nephrectomy) has most popularly been studied . In humans, diabetic nephropathy, chronic glomerulonephritis and hypertensive nephropathy are the leading causes of CKD, while the acute renal infarction is not. However, in experimental animal models, the ligation‐induced renal infarction was most typically associated with the signs of CRF, such as severe proteinuria and hypertension, as a result of the loss of functional nephron number .…”