Analysis of Factors Affecting Disease Progress and Mortality in Patients with Chronic Renal Disease

Yıl 2024, Cilt: 10 Sayı: 2, 205 - 215, 01.05.2024

Selami Bayram , Gültekin Süleymanlar , Murat Duyan , Feyza Bora

https://doi.org/10.53394/akd.1170246

Öz

Objective: To investigate the variables influencing disease progression and death in chronic renal disease patients (CKD).
Material and Methods: The design of this retrospective cross-sectional research was conducted on patients who were referred to the Nephrology Outpatient Clinic with a Glomerular Filtration Rate (GFR) <60 ml/min/1.73 m² in the emergency department and other outpatient clinics of a tertiary hospital between 2009 and 2016. A GFR decline rate of ≥5 ml/min/year was defined as "rapidly progressive" CKD and <5 ml/min/year as "slowly progressive" CKD. The endpoints were renal replacement therapy admission and death.

Results: The research comprised 737 patients, with 464 (63%) of them being men. The average duration of follow-up was 16.87 ± 18.55 months. Using RAAS blockers and hyperphosphatemia increased the rate of progression of renal disease. The presence of coronary artery disease and high proteinuria levels increased the hazard of renal replacement therapy (RRT) initiation, whereas statin and vitamin D use decreased this risk. Furthermore, the presence of heart failure, hyperphosphatemia, and anemia raised the risk of death, but using RAAS blockers, vitamin D, and high albumin levels lowered the risk of mortality.
Conclusions: CKD is a chronic illness with a significant morbidity and death rate. Recognizing and treating the factors that cause the progression of this disease will improve patient survival.

Anahtar Kelimeler

Chronic Kidney Disease, Progression, Mortality

Destekleyen Kurum

The authors declare no conflict of interest or any financial support.

Proje Numarası

The authors declare no any financial support.

Kronik Böbrek Hastaliği Olan Hastalarda Hastalik Progresyonuna Ve Mortaliteye Etki Eden Faktörlerin Analizi

Öz

Amaç: Kronik böbrek hastalığı hastalarında (KBH) hastalık progresyonu ve ölümü etkileyen değişkenleri araştırmak.
Gereç ve Yöntemler: Bu retrospektif kesitsel araştırma tasarımı, 2009 ve 2016 yılları arasında üçüncü basamak hastanenin acil servis ve diğer polikliniklerinde Glomerüler Filtrasyon Hızı (GFR) <60 ml/dk/1.73 m² ile Nefroloji Polikliniğine sevk edilen hastalar üzerinde yapılmıştır. ≥5 ml/dk/yıllık bir GFR düşüş oranı "hızlı ilerleyen" CKD ve <5 ml/dk/yıl "yavaş ilerleyen" CKD olarak tanımlandı. Son noktalar renal replasman tedavisine kabul ve ölümdü.

Bulgular: Araştırmaya 464'ü (%63) erkek olmak üzere 737 hasta dahil edildi. Ortalama takip süresi 16.87 ± 18.55 aydı. RAAS blokerleri ve hiperfosfatemi kullanımı böbrek hastalığının ilerleme hızını arttırdı. Koroner arter hastalığı ve yüksek proteinüri düzeylerinin varlığı renal replasman tedavisi (RRT) başlama riskini artırırken, statin ve D vitamini kullanımı bu riski azalttı. Ayrıca, kalp yetmezliği, hiperfosfatemi ve anemi varlığı ölüm riskini artırdı, ancak RAAS blokerleri, D vitamini ve yüksek albümin düzeylerinin kullanılması ölüm riskini azalttı.
Sonuç: KBH, önemli bir morbidite ve ölüm oranına sahip kronik bir hastalıktır. Bu hastalığın ilerlemesine neden olan faktörlerin tanınması ve tedavi edilmesi hasta sağkalımını iyileştirecektir.

Anahtar Kelimeler

Kronik Böbrek Hastalığı, İlerleme, Mortalite

Proje Numarası

The authors declare no any financial support.

Kaynakça

• 1. Scott IA, Scuffham P, Gupta D, Harch TM, Borchi J, Richards B. Going digital: a narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management. Aust Health Rev. 2020 Feb;44(1):62-82.
• 2. Acosta-Ochoa I, Bustamante-Munguira J, Mendiluce-Herrero A, Bustamante-Bustamante J, Coca-Rojo A. Impact on Outcomes across KDIGO-2012 AKI Criteria According to Baseline Renal Function. J Clin Med. 2019 Aug 28;8(9).
• 3. Weckmann GFC, Stracke S, Haase A, Spallek J, Ludwig F, Angelow A, Emmelkamp JM, Mahner M, Chenot JF. Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines. BMC Nephrol. 2018 Oct 11;19(1):258.
• 4. Saran R, Li Y, Robinson B, Abbott KC, Agodoa LY, Ayanian J, Bragg-Gresham J, Balkrishnan R, Chen JL, Cope E, Eggers PW, Gillen D, Gipson D, Hailpern SM, Hall YN, He K, Herman W, Heung M, Hirth RA, Hutton D, Jacobsen SJ, Kalantar-Zadeh K, Kovesdy CP, Lu Y, Molnar MZ, Morgenstern H, Nallamothu B, Nguyen DV, O'Hare AM.US Renal Data System 2015 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2016 Mar;67(3 Suppl 1):Svii, S1-305.
• 5. Benjamin O, Lappin SL. End-Stage Renal Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 16, 2021.
• 6. Vesga JI, Cepeda E, Pardo CE, Paez S, Sanchez R, Sanabria RM. Chronic Kidney Disease Progression and Transition Probabilities in a Large Preventive Cohort in Colombia. Int J Nephrol. 2021 Mar 31;2021:8866446.
• 7. Moyer VA; U.S. Preventive Services Task Force. Screening for chronic kidney disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(8):567-70.
• 8. Andrassy KM. Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'. Kidney Int. 2013 Sep;84(3):622-3.
• 9. Eriksen, B.O. and O.C. Ingebretsen, The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int, 2006. 69(2): p. 375-82.
• 10. Xu R, Zhang LX, Zhang PH, Wang F, Zuo L, Wang HY. Gender differences in age-related decline in glomerular filtration rates in healthy people and chronic kidney disease patients. BMC Nephrol. 2010 Aug 23;11:20.
• 11. Stojceva-Taneva O, Selim G, Stojkovski L, Ivanovski N. Hypertension and progression of nephropathy in diabetic and non-diabetic chronic kidney disease patients. Hippokratia. 2007 Apr;11(2):72-6.
• 12. Wuhl, E. and F. Schaefer, Therapeutic strategies to slow chronic kidney disease progression. Pediatric Nephrology, 2008. 23(5): p. 705-716.
• 13. Iseki, K., C. Iseki, and K. Kinjo, C-reactive protein is a predictor for developing proteinuria in a screened cohort. Nephron Clin Pract, 2011. 117(1): p. c51-6.
• 14. Wu HY, Peng YS, Chiang CK, Huang JW, Hung KY, Wu KD, Tu YK, Chien KL. Diagnostic performance of random urine samples using albumin concentration vs ratio of albumin to creatinine for microalbuminuria screening in patients with diabetes mellitus: a systematic review and meta-analysis. JAMA Intern Med. 2014 Jul;174(7):1108-15.
• 15. Halbesma N, Kuiken DS, Brantsma AH, Bakker SJ, Wetzels JF, De Zeeuw D, De Jong PE, Gansevoort RT. Macroalbuminuria is a better risk marker than low estimated GFR to identify individuals at risk for accelerated GFR loss in population screening. J Am Soc Nephrol. 2006 Sep;17(9):2582-90.
• 16. Imai E, Horio M, Yamagata K, Iseki K, Hara S, Ura N, Kiyohara Y, Makino H, Hishida A, Matsuo S. Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertens Res. 2008 Mar;31(3):433-41.
• 17. Obermayr RP, Temml C, Knechtelsdorfer M, Gutjahr G, Kletzmayr J, Heiss S, Ponholzer A, Madersbacher S, Oberbauer R, Klauser-Braun R. Predictors of new-onset decline in kidney function in a general middle-european population. Nephrol Dial Transplant. 2008 Apr;23(4):1265-73.
• 18. Hemmelgarn BR, Manns BJ, Lloyd A, James MT, Klarenbach S, Quinn RR, Wiebe N, Tonelli M; Alberta Kidney Disease Network. Relation between kidney function, proteinuria, and adverse outcomes. JAMA. 2010 Feb 3;303(5):423-9.
• 19. van der Velde M, Halbesma N, de Charro FT, Bakker SJ, de Zeeuw D, de Jong PE, Gansevoort RT. Screening for albuminuria identifies individuals at increased renal risk. J Am Soc Nephrol. 2009 Apr;20(4):852-62.
• 20. Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, Narita M, Koyama A. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney Int. 2007 Jan;71(2):159-66.
• 21. Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition. Ann Intern Med. 2002 Apr 16;136(8):604-15.
• 22. Astor BC, Matsushita K, Gansevoort RT, van der Velde M, Woodward M, Levey AS, Jong PE, Coresh J; Chronic Kidney Disease Prognosis Consortium, Astor BC, Matsushita K, Gansevoort RT, van der Velde M, Woodward M, Levey AS, de Jong PE, Coresh J, El-Nahas M, Eckardt KU, Kasiske BL, Wright J, Appel L, Greene T, Levin A. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011 Jun;79(12):1331-40.
• 23. Inker LA, Levey AS, Pandya K, Stoycheff N, Okparavero A, Greene T; Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Early change in proteinuria as a surrogate end point for kidney disease progression: an individual patient meta-analysis. Am J Kidney Dis. 2014 Jul;64(1):74-85.
• 24. Izuhara Y, Nangaku M, Inagi R, Tominaga N, Aizawa T, Kurokawa K, van Ypersele de Strihou C, Miyata T. Renoprotective properties of angiotensin receptor blockers beyond blood pressure lowering. J Am Soc Nephrol. 2005 Dec;16(12):3631-41.
• 25. Ruggenenti P, Perna A, Remuzzi G; GISEN Group Investigators. Retarding progression of chronic renal disease: the neglected issue of residual proteinuria. Kidney Int. 2003 Jun;63(6):2254-61.
• 26. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12;352(9131):837-53.
• 27. Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ. Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney Int. 2000 Jul;58(1):293-301.
• 28. Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol. 2006 Jul;17(7):2006-16.
• 29. Su X, Zhang L, Lv J, Wang J, Hou W, Xie X, Zhang H. Effect of Statins on Kidney Disease Outcomes: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2016 Jun;67(6):881-92.
• 30. Nikolic D, Banach M, Nikfar S, Salari P, Mikhailidis DP, Toth PP, Abdollahi M, Ray KK, Pencina MJ, Malyszko J, Rysz J, Rizzo M; Lipid and Blood Pressure Meta-Analysis Collaboration Group. A meta-analysis of the role of statins on renal outcomes in patients with chronic kidney disease. Is the duration of therapy important? Int J Cardiol. 2013 Oct 15;168(6):5437-47.
• 31. Gu L, Lou Q, Wu H, Ouyang X, Bian R. Lack of association between anemia and renal disease progression in Chinese patients with type 2 diabetes. J Diabetes Investig. 2016 Jan;7(1):42-7.
• 32. Kang DH, Kanellis J, Hugo C, Truong L, Anderson S, Kerjaschki D, Schreiner GF, Johnson RJ. Role of the microvascular endothelium in progressive renal disease. J Am Soc Nephrol. 2002 Mar;13(3):806-816.
• 33. Sharples EJ, Patel N, Brown P, Stewart K, Mota-Philipe H, Sheaff M, Kieswich J, Allen D, Harwood S, Raftery M, Thiemermann C, Yaqoob MM. Erythropoietin protects the kidney against the injury and dysfunction caused by ischemia-reperfusion. J Am Soc Nephrol. 2004 Aug;15(8):2115-24.
• 34. Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001 Oct;38(4):938-42.
• 35. Agarwal R, Acharya M, Tian J, Hippensteel RL, Melnick JZ, Qiu P, Williams L, Batlle D. Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney Int. 2005 Dec;68(6):2823-8.
• 36. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest. 2002 Jul;110(2):229-38.
• 37. Goicoechea M, de Vinuesa SG, Verdalles U, Ruiz-Caro C, Ampuero J, Rincón A, Arroyo D, Luño J. Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Nephrol. 2010 Aug;5(8):1388-93.
• 38. Bellomo G, Venanzi S, Verdura C, Saronio P, Esposito A, Timio M. Association of uric acid with change in kidney function in healthy normotensive individuals. Am J Kidney Dis. 2010 Aug;56(2):264-72.
• 39. Yamada, T., et al., Elevated Serum Uric Acid Predicts Chronic Kidney Disease. American Journal of the Medical Sciences, 2011. 342(6): p. 461-466.