Results from a five-year study showed that most chronic kidney disease (CKD) patients have benign disease and are at low risk of disease progression and complications.
The study, “Chronic Kidney Disease in Primary Care: Outcomes after Five Years in a Prospective Cohort Study,” was published in the journal PLOS Medicine.
“These results will help clinicians explain the likely outcomes of chronic kidney disease to patients diagnosed with CKD in the community. In contrast to common ideas about CKD, we have shown the majority people in our cohort were stable over the five-year follow-up period, with a significant minority demonstrating improvement,” Adam Shardlow, the study’s lead researcher, said in a news release. “Those with a high risk of progression can be identified using simple measures and referred early to specialist services.”
Previous studies, conducted at large teaching hospitals, have highlighted the risk of end-stage kidney disease, but the results may not be applicable to many people with CKD because most have mild disease, receive care from family doctors, and are never referred to a kidney specialist.
To better understand the risks associated with CKD, with the goal of providing a perspective that is applicable to most with the disease, Shardlow and colleagues at the The University of Nottingham’s School of Medicine, based at the Royal Derby Hospital, followed 1,741 people with CKD stage 3.
The Kidney Disease: Improving Global Outcomes (KDIGO) criteria was used to define CKD progression, and CKD remission was defined as the absence of diagnostic criteria (estimated glomerular filtration rate [eGFR] >60 ml/min/1.73m2, and urine albumin-to-creatinine ratio [uACR] <3mg/mmol). Each patient was measured at study entry and again after one and five years.
Researchers found that after five years, most people (34 percent) had stable kidney function. In addition, only a very small minority (4 people or 0.2 percent) were seen to develop end-stage kidney disease, and 18 percent evidenced less severe progression.
Of note, the researchers found that 19 percent of the people had improvements in their kidney function, no longer having evidence of CKD.
According to the researchers, the results “emphasize that the management of CKD by family doctors should focus on identifying the minority of people who are at high risk of adverse outcomes for more intensive treatment and referral to a kidney specialist.”
Guiseppe Remuzzi and Richard Glassock, in an accompanying editorial, noted progress being made in the classification and diagnosis of CKD, and in the challenges of pinpointing surveillance factors that can predict patients are at risk of CKD progression. The new study “identifies factors, easily obtained and possibly modifiable, that should heighten surveillance for the minority of subjects with CSK Stage 3 who are at risk for progression,” they said.
Chronic kidney disease is a condition characterized by a gradual loss of kidney function over time, and affects an estimated 10 percent to 20 percent of adults worldwide. Early detection and treatment can often keep CKD from worsening.