Risk factors of progression of chronic kidney disease patients under conservative treatment

Tarek A. Ghonemy, Salama Elsayed Farag, Sameh A. Soliman


Background: Chronic kidney disease (CKD) is recognized as a major health problem affecting approximately 13% of the US population. Early identification and treatment of risk factors of progression of chronic kidney disease can provide marked benefits later in the term of delaying progression to renal replacement therapy.

Methods: The medical chart for 92 CKD patients on regular follow up in low clearance clinic with GFR below 20 ml/min were retrospectively reviewed annually for 4 years regular follow up period. The following variables were recorded for each patient: non-modifiable variables (Age, sex, nationality, BMI, systolic and diastolic blood pressure, smoking status, causes of kidney disease, diabetes status, hepatitis status, medication used (like ACEi/ARBs and Sodium bicarbonate) and modifiable variables which includes: Serum albumin, potassium level, serum bicarbonate level, level of proteinuria, rate of GFR decline (Delta GFR) /year, total cholesterol level and hemoglobin level. Then they were divided into 2 groups according to the endpoint during the follow up period. Group 1 include patients did not start dialysis yet and group 2 which include patients who started dialysis during their regular follow up period.

Results: There is no statistically significant differences between the two groups regarding Age , sex, systolic and diastolic blood pressure and Body Mass Index( BMI), serum albumin and haemoglobin levels (p 0.295, 0.317, 0.220, 0.181,0.805, 0.884 and 0.451 respectively). There is no statistically a difference between the two groups regarding serum potassium level and serum total cholesterol level (p 0.515 and 0.517 respectively). Diabetic patients started dialysis earlier than non-diabetics with statistically significant difference between the two groups (p 0.029). The patients who weren’t taking ACEi or ARBs started dialysis earlier than those who were taking (p 0.005), while there was no significant differences between the two groups regarding sodium bicarbonate intake (p 0.256). Low sodium bicarbonate level and severity of proteinuria are of significantly important risk factors for progression of CKD disease (p 0.006 and 0.029 respectively).

Conclusions: The most important risk factors for rapid progression are presence of diabetes, severity of proteinuria and low serum bicarbonate level in advanced stages of chronic kidney disease. Early recognition of these risk factors and their correction may retard the progression of CKD, which will delay the need for renal replacement therapy. In addition, ACEI or ARBs intake are almost renoprotective and may delay the rapid progression of chronic kidney disease especially in proteinuric patients.



Chronic kidney disease, Risk factors, Progression

Full Text:



K/DOQI clinical practice guidelines for chronic kidney disease. Evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.

United States Renal Data System, USRDS (2010) Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.

United States Renal Data System. USRDS( 2013) Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD.

Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann. Intern. Med. 2003;139:137-47.

Formica RN. CKD series: Delaying the progression of chronic kidney disease. Hosp. Physician. 2003;43:24-33.

Haroun MK, Jaar BG, Hoffman SC, et al. Risk factors forchronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland. J Am Soc Nephrol. 2003;14:2934-41.

Jungres P, Chauveau P, Descamps-Latscha B. Age and gender-related incidence of chronic renal failure in a French urban: a prospective epidemiologic study. Nephrol Dial Transplant. 1996;11:1542-6.

David N, Ali M, Rebecca B, Richard H , Philip A. K, Donal O’Donoghue, et al. Body mass index has no effect on rate of progression of chronic kidney disease in subjects with type 2 diabetes mellitus. J Nephro. 2012;25(03):384-93.

Khedr A, Khedr E, House AA. Body mass index and the risk of progression of chronic kidney disease. J Ren Nutr. 2011;21(6):455-61.

Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am. J. Kidney Dis. 2003;41: 1-12.

Levin A. The relationship of haemoglobin level and survival: direct or indirect effects? Nephrol. Dial. Transplant. 2002;17(suppl 5):8-13.

Krolewski AS, Warram JH, Christlieb AR. Hypercholesterolemia. A determinant of renal functional loss and deaths in IDDM patients with nephropathy. Kidney Int. 1994;45(suppl. 45):S125-31.

Phillip M, Hall MD. Prevention of Progression in Diabetic Nephropathy. Diabetes Spectrum. 2006;1:18-24.

Maschio G, Alberti D, Janin G, Locatelli F, Mann JF, Motolese M, et al. for the Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group: Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med. 1996;334:939–45.

Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G. Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Lancet. 1998;352:1252-6.

Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccali C, Salvadori M, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999;354:359-64.

The GISEN Group. Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet. 1997;349:1857-63.

Jungers P, Hannnnedouche T, Itakura Y, Albouze G, Descamps-Latscha B, Man NK. Progression rate to end stage renal failure in non-diabetic kidney disease: a multivariate analysis of determinant factors. Nephrol Dial Transplant. 1995;10:1353-60.

de Goeij MC, Liem M, de jager DJ, Voormolen N, Sijpkens YW, Rotmans JI, et al. Proteinuria as a Risk Marker for the Progression of Chronic Kidney Disease in Patients on Predialysis Care and the Role of Angiotensin Converting Enzyme Inhibitor / Angiotensin II Receptor Blocker Treatment. Nephron Clin Pract. 2012;121:c73-c82.

Dobre M, Yang W, Chen J, Drawz P, et al. Association of Serum Bicarbonate With Risk of Renal and Cardiovascular Outcomes in CKD: A Report From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2013;62(4):670-8.