Risk factors for chronic kidney disease progression in patients with solitary kidney

Year 2022, , 342 - 347, 15.03.2022

Refika Karaer Büberci , Murat Duranay

https://doi.org/10.32322/jhsm.1009811

Abstract

Introduction: The prevalence of chronic kidney disease (CKD) is rapidly increasing worldwide. Solitary kidney is also increasing in ranking among the CKD etiologies, because there has been a rapid increase in the number of radical nephrectomies due to an increased number of renal transplantations from live donors and an increased number of patients with renal cell carcinoma. The aim of the current study is to identify risk factors that affect the glomerular filtration rate (GFR) in individuals with solitary kidney.
Material and Method: The current study included 204 patients (75 with congenital, 129 with acquired solitary kidney). Laboratory data during the first and last admissions were recorded. Patients divided into two groups according to annual decline of eGFR. Group I and II consisted of patients whose annual decline eGFR was more than 1ml/min/1.73 m2 and less than 1ml/min/1.73 m2, respectively. In addition, patients were divided into two groups as patients with congenital and acquired solitary kidney. The first control is the first examination in the nephrology outpatient clinic for congenital solitary kidney patient and the post-operative examination on the fourteenth day after discharge from the hospital for the acquired solitary kidney patient. The final control is the examination within the last three months before reaching the primary endpoint of the study.
Results: Of the patients, 36.8% were male, and the average age was 57.16±15.04 years. The duration of the follow-up period was 6.48±3.69 years. Group I had higher rates of diabetes mellitus, cardiovascular disease, older age, higher mean blood pressure(MBP), glucose, CRP, total cholesterol (TC), LDL-cholesterol, non-HDL-cholesterol, triglyceride/non-HDL-cholesterol ratio and lower albumin. In the group with acquired solitary kidney, the patients were older, the incidence of cardiovascular diseases was higher, and the eGFR at the first and last admission was lower. There was no difference between acquired SK and congenital SK in terms of annual change in eGFR. In regression analysis CRP, LDL-cholesterol, non-HDL-cholesterol, TG/non-HDL-cholesterol ratio are independent risk factors on annual decline of eGFR. Having a congenital or acquired single kidney had no effect on the annual decline of eGFR. In addition, TC, TC/HDL-cholesterol, triglyceride/non-HDL-cholesterol, triglyceride/HDL-cholesterol ratios, non-HDL -cholesterol correlated with CRP positively.
Conclusıon:Patients with solitary kidney have higher risk of developing CKD. Inflammation and dyslipidemia must be paid attention to protect eGFR. Besides the atherosclerosis in the microcirculation, dyslipidemia affect eGFR through inflammation. Having a congenital or acquired single kidney has no effect on the annual decline of eGFR.

Keywords

Dyslipidemia, Glomerular filtration rate, Inflammation, Proteinuria, Solitary kidney

References

• Takemoto Y, Toshihide N. Economic issues of chronic kidney disease and End-Stage Renal Disease. Contrib Nephrol 2019; 198: 87-93.
• Subbiah AK, Chhabra YK, Mahajan S. Cardiovascular disease in patients with chronic kidney disease: A neglected subgroup. Heart Asia 2016; 8: 56-61.
• Sharabas I, Siddiqi N. Cardiovascular disease risk profiles comparison among dialysis patients. Saudi J. Kidney Dis. Transplant 2016; 27: 692-700.
• Maggiore U, Budde K, Heemann U, et al. Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group. Nephrol Dial Transplant 2017; 32: 216–23.
• Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. New Engl J Med 2009; 360: 459–69.
• Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation. JAMA 2014; 311: 579–86.
• Mjoen G, Hallan S, Hartmann A, et al. Long-term risks for kidney donors. Kidney Int 2014; 86: 162–7.
• Kim S, Chang Y, Lee YR, et al. Solitary kidney and risk of chronic kidney disease. Eur J Epidemiol 2019; 34: 879-88.
• Tantisattamo E, Dafoe DC, Reddy UG, et al. Current management of patients with acquired solitary kidney. Kidney Int Rep 2019; 4: 1205-18.
• Nishi H, Higashihara T, Inagi R. Lipotoxicity in kidney, heart, and skeletal muscle dysfunction. Nutrients 2019; 11: 1664.
• Khan S, Cabral PD, Schilling WP, et al. Kidney proximal tubule lipoapoptosis is regulated by fatty acid transporter-2 (FATP2). J Am Soc Nephrol 2018; 29: 81–91.
• Rysz J, Gluba-Brzózka A, Rysz-Górzyńska M, Franczyk B. The role and function of HDL in patients with chronic kidney disease and the risk of cardiovascular disease. Int J Mol Sci 2020; 21: 601.
• Chen SC1, Hung CC, Kuo MC, et al. Association of dyslipidemia with renal outcomes in chronic kidney disease. PLoS One 2013; 8: e55643.
• Schaeffner ES, Kurth T, Curhan GC et al. Cholesterol and the risk of renal dysfunction in apparently healthy men. J Am Soc Nephrol 2003; 14: 2084–91.
• Wen J , Chen Y, Huang Y. Association of the TG/HDL-C and non-HDL-C/HDL-C ratios with chronic kidney disease in an adult Chinese population. Kidney Blood Press Res 2017; 42: 1141-54.
• Sanguankeo A, Upala S, Cheungpasitporn W, Ungpraser P, Knight EL. Effects of statins on renal outcome in chronic kidney disease patients: a systematic review and meta-analysis. PLoS One 2015; 10: e0132970.
• Abou Jaoude P, Dubourg L, Bacchetta J, et al. Congenital versus acquired solitary kidney: is the difference relevant? Nephrol Dial Transplant 2011; 26: 2188–94.