Risk factors for progression of chronic kidney disease

Abstract

Purpose of review: The present review provides an overview of the identified risk factors for chronic kidney disease (CKD) progression emphasizing the pediatric population.

Recent findings: Over the past 10 years, there have been significant changes to our understanding and study of preterminal kidney failure. Recent refinements in the measurement of glomerular filtration rate and glomerular filtration rate estimating equations are important tools for identification and association of risk factors for CKD progression in children. In pediatric CKD, lower level of kidney function at presentation, higher levels of proteinuria, and hypertension are known markers for a more rapid decline in glomerular filtration rate. Anemia and other reported risk factors from the pregenomic era require further study and validation. Genome-wide association studies have identified genetic loci that have provided novel genetic risk factors for CKD progression.

Summary: With cohort studies of children with CKD becoming mature, they have started to yield important refinements to the assessment of CKD progression. Although many of the traditional risk factors for renal progression will certainly be assessed, such cohorts will be important for evaluating novel risk factors identified by genome-wide studies.

Figure 1. Level of Proteinuria by level of GFR

Urine Protein:Creatinine ratios (Up/c) by iohexol-measured glomerular filtration rate (iGFR)) for 328 non-glomerular CKD children and 91 glomerular CKD children, respectively. Non-parametric smoothing splines for the Up/c vs iGFR relationship for each of the CKD diagnosis groups are represented by the small dashed lines. Linear regression models for the non-glomerular and glomerular CKD patients are represented by the solid and large dashed straight lines, respectively. [Reproduced with permission from [26]]