Factors related with the progression of chronic kidney disease
- Autores: Claudia Yuste, Daniel Barraca, Inés Aragoncillo Sauco, Almudena Vega Martínez, Soraya Abad, Úrsula Verdalles Guzmán, Caridad Ruiz Caro, Jara Ampuero, Juan M. López Gómez
- Localización: Nefrología: publicación oficial de la Sociedad Española de Nefrología, ISSN 0211-6995, Vol. 33, Nº. 5, 2013, págs. 685-691
- Idioma: inglés
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Resumen
Background:
Our aims were to determine the rate of progression of chronic kidney disease (CKD) and to identify predictors, with particular emphasis on bone and mineral metabolism.
Methods:
Retrospective and observational study including 300 patients with advanced CKD (61.2% males, 33.1% diabetics; age 65.6±14 years). Mean follow-up time was19.4±10.1 months. Baseline estimated glomerular filtration rate (eGFR) (MDRD-4) was 22.5±7.18mL/min. To calculate the rate of decline in eGFR, we used the slope of the regression line between all determinations of eGFR and follow-up time. We calculated the mean values for proteinuria and serum phosphate, calcium, uric acid, and PTH, as well as 24-hour urinary excretion of urea nitrogen over time for each patient. Follow-up was at least 6 months and included at least 4 measurements of eGFR.
Results:
The mean rate of decline eGFR (�1.64 mL/min/1.73m 2 / year) was inversely correlated with serum phosphate levels (4.3±2.1 mg/dL, P <.001), PTH (256.3±193.7ng/L, p<.001) and proteinuria (0.84±1.31g/day, P =.004) and directly correlated with mean serum calcium ( P <.001) and the presence of hypertension ( P <.02). However, only serum phosphate, serum PTH, and proteinuria persisted as predictors in the multivariate analysis. Stable-GFR patients (positive slope) were older ( P =.041) and had lower serum phosphate and PTH levels ( P <.01 and P <.01 respectively) and lower proteinuria ( P <.01).
Conclusions:
The rate of decrease in eGFR was correlated with serum phosphate and PTH levels and proteinuria. All of these factors can be modified with an adequate treatment
