Risk Factors for Development and Progression of Chronic Kidney Disease

Tsai, Wan‐Chuan; Wu, Hon-Yen; Peng, Yu‐Sen; Ko, Mei‐Ju; Wu, Ming-Shiou; Hung, Kuan‐Yu; Wu, Kwan‐Dun; Chu, Tzong‐Shinn; Chien, Kuo–Liong

doi:10.1097/md.0000000000003013

Cited by 133 publications

(108 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The disease accounted for 53.61% of the cases in the present study, which is similar to previous studies that reported 55% (3,4). Hypertension is a risk factor of CKD and also a common complication of CKD (22,23). With the progression of CKD, 80-85% patients have elevated blood pressure.…”

Section: % CI ------------------------------Variablesupporting

confidence: 80%

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Wei

Lin

Yang

et al. 2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD), and its development and progression are affected by various factors. The aim of the present study was to identify the risk factors for SHPT in patients with CKD. A retrospective study was performed in 498 patients (305 males and 193 females) with CKD, observed in the The First Hospital of Jilin University between January 2008 and December 2012. The demographic, clinical and laboratory data were collected. Patients were divided into the SHPT group (n=424) with elevated serum parathyroid hormone (PTH) expression levels and the control group (n=74) with normal serum PTH expression levels. Univariate and multivariate regression analyses were employed to explore the risk factors for SHPT. Serum PTH expression levels in women with CKD were significantly higher than in men (P= 0.047). Serum PTH expression levels were positively correlated with the expression levels of serum creatinine (P<0.01), phosphorus (P<0.01), C-reactive protein (P<0.05), triglyceride (P<0.05), cholesterol (P<0.05) and low-density lipoprotein cholesterol (P<0.05), but were negatively correlated with the expression levels of hemoglobin (P<0.05), calcium (P<0.01) and CO 2 combining power (P<0.01) in patients with CKD. Multivariate analysis showed that the serum expression levels of creatinine [µmol/l; odds radio (OR), 1.003; 95% confidence interval (CI), 1.002-1.004; P=0.001] and phosphorus (mmol/l; OR, 2.19; 95% CI, 1.254-3.826; P=0.006) in patients with CKD significantly influenced serum PTH expression levels. The SHPT risk factors include female gender, low calcium, high phosphorus, acidosis, anemia, hypertension, hyperlipidemia and micro-inflammation, with blood phosphorus and creatinine being independent risk factors. IntroductionThe incidence of chronic kidney disease (CKD) is rapidly increasing, posing a serious health problem worldwide. More than 16 million adults are affected by end stage CKD in the USA (1,2). Abnormal serum calcium, phosphorus and parathyroid hormone (PTH) expression levels are common challenges in the management of CKD (3,4). These biochemical abnormalities, together with the dysregulation of vitamin D metabolism and bone turnover, constitute a systemic syndrome termed CKD mineral and bone disorder (CKD-MBD) (5).Secondary hyperparathyroidism (SHPT) is a common complication of patients with CKD, which is characterized by increased blood PTH levels, and abnormal mineral and bone metabolism (6). It is associated with increased morbidity and mortality, and adversely influences the quality of life of patients with CKD (3,6). The incidence of SHPT is reported to increase with the stage of CKD: 40% in stage 3, 70% in stage 4 and >80% in stage 5 (4,7).The kidneys are vital organs regulating calcium and phosphorous homeostasis (8). SHPT is an adaptive pathophysiological process in response to deteriorating renal insufficiency (6). The fundamental mechanism of PTH in kidneys is to suppress the reabsorption of phosphate in the pro...

show abstract

Section: % CI ------------------------------Variablesupporting

confidence: 80%

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Wei

Lin

Yang

et al. 2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

show abstract

“…Many studies suggest that male sex is associated with worse renal outcomes [21-24], consistent with the present study (Table 2). Sex differences exist in the pathogenesis and clinical prognosis of CKD [25], and female sex seems to be renoprotective for the development and progression of CKD.…”

Section: Discussionsupporting

confidence: 82%

“…The results of studies on elderly status as a prognostic factor for renal prognosis have been inconsistent [21]. In the present study, although elderly status was associated with slightly better renal outcomes in the total cohort (Table 2), the prognostic characteristics of elderly patients in the Kaplan-Meier analyses differed according to the BMI-based cross-classified subcohort (Fig.…”

Section: Discussioncontrasting

confidence: 46%

“…DM is generally considered a prognostic factor for the development and progression of CKD [21]. Although the total-cohort multivariate Cox analysis did not show significant differences in renal prognostic factors between patients with and without DM, the Kaplan-Meier analysis for the total cohort showed a significantly worse prognosis in terms of the 4-year renal survival rate in the patients with DM (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Among the identified prognostic factors in the present study, albuminuria [31], kidney impairment [24, 31-34], male sex [21-24, 34-36], hyperphosphatemia [37-42], anemia [31, 32, 37, 43, 44], hypoalbuminemia [31], overweight/obesity [45, 46], younger age [32, 34], increased iPTH [47], and decreased urinary potassium excretion [48-50] have been previously reported as renal prognostic factors for CKD [21, 51, 52]. However, there are no reports using a BMI-based cross-classification approach for the assessment of prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Body Mass Index-Based Cross-Classification Approach for the Assessment of Prognostic Factors in Chronic Kidney Disease Progression

Kataoka

Ono

Mochizuki

et al. 2019

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Cross-classification analyses are rarely reported. We investigated the prognostic factors for chronic kidney disease (CKD) progression using a body mass index (BMI)-based cross-classification approach. Methods: Patients’ renal outcome (≥50% decline in the estimated glomerular filtration rate or end-stage renal disease) in each subcohort was examined. Results: The number of prognostic factors identified in the multivariate Cox analysis was smaller in the “BMI ≥25, female” and CKD stage 3 subcohorts than in other subcohorts. Prognostic factors identified in the “BMI ≥25, CKD stage 3” subcohort only comprised albuminuria and male sex, and those in the “BMI ≥25, female” subcohort only comprised albuminuria, hyperphosphatemia, and anemia. Albuminuria, kidney impairment, male sex, hyperphosphatemia, anemia, and increased pulse pressure × heart rate product (PP × HR; pulsatile stress) were stable renal prognostic factors in almost all subcohorts. On the other hand, the prognostic value of increased BMI, younger age, hypoalbuminemia, increased intact parathyroid hormone, and decreased estimated 24-h urinary potassium excretion (e24hUK) differed according to subcohort. BMI was positively associated with CKD progression in the “BMI ≥25, age ≥65 years” and “BMI ≥25, CKD stages 4–5” subcohorts, whereas it was negatively associated with CKD progression in the “BMI <25, diabetes mellitus” subcohort. PP × HR was independently associated with CKD progression in the “BMI <25, CKD stage 3” subcohort, which had relatively few identified renal prognostic factors. Decreased e24hUK was a renal prognostic factor for CKD progression in the “BMI <25, CKD stages 4–5” subcohort, while no significant factors were observed in the “BMI ≥25, CKD stages 4–5” subcohort. Conclusion: A BMI-based cross-classification approach, which provides more comprehensive findings than that in previous approaches, is expected to be an effective method for evaluating renal prognostic factors in patients with CKD who are affected by multiple risk factors.

show abstract

Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease

et al. 2017

Self Cite

View full text Add to dashboard Cite

IMPORTANCE The optimal blood pressure (BP) target remains debated in nondiabetic patients with chronic kidney disease (CKD). OBJECTIVE To compare intensive BP control (<130/80 mm Hg) with standard BP control (<140/90 mm Hg) on major renal outcomes in patients with CKD without diabetes. DATA SOURCES Searches of PubMed, MEDLINE, Embase, and Cochrane Library for publications up to March 24, 2016. STUDY SELECTION Randomized clinical trials that compared an intensive vs a standard BP target in nondiabetic adults with CKD, reporting changes in glomerular filtration rate (GFR), doubling of serum creatinine level, 50% reduction in GFR, end-stage renal disease (ESRD), or all-cause mortality. DATA EXTRACTION AND SYNTHESIS Random-effects meta-analyses for pooling effect measures. Meta-regression and subgroup analyses for exploring heterogeneity. MAIN OUTCOMES AND MEASURES Differences in annual rate of change in GFR were expressed as mean differences with 95% CIs. Differences in doubling of serum creatinine or 50% reduction in GFR, ESRD, composite renal outcome, and all-cause mortality were expressed as risk ratios (RRs) with 95% CIs. RESULTS We identified 9 trials with 8127 patients and a median follow-up of 3.3 years. Compared with standard BP control, intensive BP control did not show a significant difference on the annual rate of change in GFR (mean difference, 0.07; 95% CI, −0.16 to 0.29 mL/min/1.73 m 2 /y), doubling of serum creatinine level or 50% reduction in GFR (RR, 0.99; 95% CI, 0.76-1.29), ESRD (RR, 0.96; 95% CI, 0.78-1.18), composite renal outcome (RR, 0.99; 95% CI, 0.81-1.21), or all-cause mortality (RR, 0.81; 95% CI, 0.64-1.02). Intensive BP control reduced mortality (RR, 0.78; 95% CI, 0.61-0.99) in sensitivity analysis when the study populations were strictly restricted to those without diabetes. Nonblacks and patients with higher levels of proteinuria showed a trend of lower risk of kidney disease progression with intensive BP control. CONCLUSIONS AND RELEVANCE Targeting BP below the current standard did not provide additional benefit for renal outcomes compared with standard treatment during a follow-up of 3.3 years in patients with CKD without diabetes. However, nonblack patients or those with higher levels of proteinuria might benefit from the intensive BP-lowering treatments.

show abstract

Risk Factors for Development and Progression of Chronic Kidney Disease

Abstract: Supplemental Digital Content is available in the text

Cited by 133 publications

References 42 publications

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

A Body Mass Index-Based Cross-Classification Approach for the Assessment of Prognostic Factors in Chronic Kidney Disease Progression

Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease

Contact Info

Product

Resources

About