Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Abstract

Background: Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear estimated glomerular filtration rate (eGFR) trajectory represent a clear paradigm for understanding true CKD progression.

Methods: A linear regression slope was applied to all outpatient eGFR values for patients in the Salford Kidney Study who had ≥2 years follow-up, ≥4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤ - 4 ml/min/1.73m²/yr defined rapid progressors, whereas - 0.5 to + 0.5 ml/min/1.73m²/yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD.

Results: There were 157 rapid progressors (median ΔeGFR - 5.93 ml/min/1.73m²/yr) and 179 stable patients (median ΔeGFR - 0.03 ml/min/1.73m²/yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of > 50 g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure.

Conclusions: There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

Keywords: CKD; Chronic kidney disease; End-stage renal disease; Mortality; Prediction; Progression.

Fig. 1

Patient selection from the Salford Kidney Study (SKS)

Fig. 2

Outcomes for rapid progressors and stable patients. Abbreviations: HD (haemodialysis); PD (peritoneal dialysis)

Fig. 3

Kaplan Meier curve for probability of survival from ESRD

Fig. 4

Kaplan Meier curve for probability of survival from death prior to ESRD

Fig. 5

Kaplan Meier curve for probability of survival from ESRD or death prior to ESRD