Stabilization of Glomerular Filtration Rate in Advanced Chronic Kidney Disease: A Two-Year Follow-up of a Cohort of Chronic Kidney Disease Patients Stages 4 and 5

Serrano, Andrés; Huang, Jie; Ghossein, Cybele; Nishi, Laura; Gangavathi, Anupama; Madhan, Vijayachitra; Ramadugu, P.; Ahya, Shubhada N.; Paparello, James J.; Khosla, Neenoo; Schlueter, William; Batlle, Daniel

doi:10.1053/j.ackd.2006.07.009

Cited by 16 publications

(14 citation statements)

References 33 publications

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“…Although progress has been made in retarding the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD), the prevalence of CKD as a whole is rising in the United States and worldwide [1-5]. CKD is associated with increased morbidity and mortality, a negative impact on quality of life, progression to ESRD, and represents an important burden for the healthcare system [3,4].…”

Section: Introductionmentioning

confidence: 99%

Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in spain: the MERENA observational cohort study

et al. 2011

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BackgroundTo obtain information on cardiovascular morbidity, hypertension control, anemia and mineral metabolism based on the analysis of the baseline characteristics of a large cohort of Spanish patients enrolled in an ongoing prospective, observational, multicenter study of patients with stages 3 and 4 chronic kidney diseases (CKD).MethodsMulticenter study from Spanish government hospital-based Nephrology outpatient clinics involving 1129 patients with CKD stages 3 (n = 434) and 4 (n = 695) defined by GFR calculated by the MDRD formula. Additional analysis was performed with GFR calculated using the CKD-EPI and Cockcroft-Gault formula.ResultsIn the cohort as a whole, median age 70.9 years, morbidity from all cardiovascular disease (CVD) was very high (39.1%). In CKD stage 4, CVD prevalence was higher than in stage 3 (42.2 vs 35.6% p < 0.024). Subdividing stage 3 in 3a and 3b and after adjusting for age, CVD increased with declining GFR with the hierarchy (stage 3a < stage 3b < stage 4) when calculated by CKD-EPI (31.8, 35.4, 42.1%, p 0.039) and Cockcroft-Gault formula (30.9, 35.6, 43.4%, p 0.010) and MDRD formula (32.5, 36.2, 42.2%,) but with the latter, it did not reach statistical significance (p 0.882). Hypertension was almost universal among those with stages 3 and 4 CKD (91.2% and 94.1%, respectively) despite the use of more than 3 anti-hypertensive agents including widespread use of RAS blockers. Proteinuria (> 300 mg/day) was present in more than 60% of patients and there was no significant differences between stages 3 and 4 CKD (1.2 ± 1.8 and 1.3 ± 1.8 g/day, respectively). A majority of the patients had hemoglobin levels greater than 11 g/dL (91.1 and 85.5% in stages 3 and 4 CKD respectively p < 0.001) while the use of erythropoiesis-stimulating agents (ESA) was limited to 16 and 34.1% in stages 3 and 4 CKD respectively. Intact parathyroid hormone (i-PTH) was elevated in stage 3 and stage 4 CKD patients (121 ± 99 and 166 ± 125 pg/mL p 0.001) despite good control of calcium-phosphorus levels.ConclusionThis study provides an overview of key clinical parameters in patients with CKD Stages 3 and 4 where delivery or care was largely by nephrologists working in a network of hospital-based clinics of the Spanish National Healthcare System.

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Section: Introductionmentioning

confidence: 99%

Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in spain: the MERENA observational cohort study

et al. 2011

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“…Conversely, there was a group of patients with similar levels of renal function at presentation (median eGFR at presentation 28.6 ml/min/1.73 m 2 ) whose renal function had deteriorated significantly in the 9 months prior to presentation but in >85% of whom renal function either stabilized or actually improved in the subsequent 12 months. Such clinically important changes in renal function in patients with CKD stage 4 or 5 have been previously documented [45].…”

Section: Discussionmentioning

confidence: 92%

“…The relationship between improved blood pressure control and reduction in the rate of progression is well documented [46]. There is also good evidence for the renoprotective effects of statins [45] and blockade of the rennin-angiotensin system [46,47]. Thus it is possible that the effects seen on the rate of progression of renal impairment are related to the reductions observed in blood pressure and cholesterol.…”

Section: Discussionmentioning

confidence: 97%

Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes

Richards

Harris

Whitfield

et al. 2007

Nephrology Dialysis Transplantation

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Background. The majority of patients with chronic kidney disease (CKD) stages 3-5 are managed within primary care. We describe the effects, on patient outcomes, of the introduction of an algorithm-based, primary care disease management programme (DMP) for patients with CKD based on automated diagnosis using estimated glomerular filtration rate (eGFR) reporting. Results. Four hundred and eighty-three patients with CKD stage 4 or 5 were enrolled in the programme. There were significant improvements in the following parameters, expressed as median values (interquartile range) after 9 months in the programme, compared to baseline and percentage values patients achieving target at 9 months: total cholesterol 4.2 (3.45-5.0) mmol/l versus 4.6 (3.9-5.4) mmol/l (P < 0.01), 75.0% versus 64.5% (P < 0.001); LDL 2.2 (1.6-2.8) mmol/l versus 2.5 (1.9-3.2) mmol/l (P < 0.01), 81.9% versus 69.2% (P < 0.05); systolic blood pressure 130 (125-145) mmHg versus 139 (124-154) mmHg (P < 0.05), 56.2% versus 37.1% (P < 0.05) and diastolic blood pressure 71 (65-79) mmHg versus 76 (69-84) mmHg (P < 0.01), 68.4% versus 90.3% (P < 0.01).The median fall (interquartile range) in eGFR in the 9 months prior to joining the programme was 3.69 (1.49-7.46) ml/min/1.73 m 2 compared to 0.32 (−2.61-3.12) ml/min/1.73 m 2 in the 12 months after enrolment (P < 0.001). One hundred and twenty-two patients experienced a fall in eGFR of ≥5 ml/min/1.73 m 2 , median 9.90 (6.55-12.36) ml/min/1.73 m 2 in the 9 months prior to joining the programme, whilst in the 12 months after enrolment, their median fall in eGFR was −1.70 (−6.41-1.64) ml/min/1.73 m 2 (P < 0.001). In the remaining patients, the median fall in eGFR was 1.92 (0.41-3.23) ml/min/1.73 m 2 prior to joining the programme and 0.86 (−1.03-3.53) ml/min/1.73 m 2 in the 12 months after enrolment (P = 0.082). Conclusions. These data suggest that chronic disease management in this form is an effective method of identifying and managing patients with CKD within the UK. The improvement in cardiovascular risk factors and reduction in the rate of decline of renal function potentially have significant health benefits for the patients and should result in cost savings for the health economy.

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“…In a study based on a longitudinal follow-up of a cohort of 82 patients with stages 4 and 5 CKD primarily referred to a CKD Clinic, we found that stabilization of GFR over a period of 2 years is possible in a large number of subjects. 13. The longitudinal follow-up of 2 years started with the initiation of erythropoietin therapy for management of anemia using epoietin a, at starting dose of 100 m/kg/week.…”

Section: Role Of Ckd Clinicsmentioning

confidence: 99%

“…A study from a CKD clinic, of a cohort of 82 patients with advanced CKD, stages 4 and 5 followed for 2 years since initiation of erythropoietin therapy showed stabilization of GFR in more than 50% of patients. 13 We therefore propose that CKD clinics will have a decisive role in preventing and delaying the progression to advanced CKD.…”

mentioning

confidence: 99%

Progress in retarding the progression of advanced chronic kidney disease: Grounds for optimism

Batlle

Ramadugu

Soler

2006

Kidney International

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It has been generally held that once glomerular filtration rate (GFR) falls below approximately 25 ml/min, a relentless progression to end-stage renal disease (ESRD) inevitably ensues, regardless of the original cause of reduced function. There is a paucity of contemporary studies, however, addressing whether the rate of progression can be slowed down with contemporary and comprehensive renal care when chronic kidney disease (CKD) has progressed to stages 4 and 5 (GFRo30 ml/min/1.73 m 2 ). In this review we argue that significant progress is being made already in retarding the progression of advanced CKD thereby delaying the initiation of renal replacement therapy. We propose that CKD clinics, by providing comprehensive management of CKD, will have a decisive role in preventing and delaying the progression to advanced CKD.

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Stabilization of Glomerular Filtration Rate in Advanced Chronic Kidney Disease: A Two-Year Follow-up of a Cohort of Chronic Kidney Disease Patients Stages 4 and 5

Cited by 16 publications

References 33 publications

Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in spain: the MERENA observational cohort study

Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in spain: the MERENA observational cohort study

Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes

Progress in retarding the progression of advanced chronic kidney disease: Grounds for optimism

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