Журнал нефрологии и терапии

Analysis of Predictive Factors for Deterioration of Renal Function in Chronic Kidney Disease Patients

Abstract

Keiichi Matsuzaki ,Hitoshi Suzuki ,Takashi Kobayashi ,Yoshio Shimizu ,Yasuhiko Tomino *

Chronic kidney disease (CKD) management requires a multidisciplinary approach. Although several treatment targets exist, the relationships between a number of clinical criteria and CKD progression have not been studied. Here, we investigated the association between renal dysfunction progression and a number of clinical parameters. We retrospectively enrolled 373 patients with mild impaired renal function indicated by a serum creatinine level > 2.0 mg/dL measured in 2012. We assessed clinical parameters both in 2009 and 2012, and analyzed whether each clinical parameter (e.g., hypertension, diabetes, dyslipidemia, and anemia) met therapeutic targets. We defined a 50% increase in serum creatinine level as baseline, and determined the progression and non-progression groups based on this definition. Systolic blood pressure (SBP), estimated glomerular filtration rate (eGFR), triglyceride, and urinary protein were significantly different between the progression and non-progression groups. The percentage of individuals in the non-progression group decreased with increasing proteinuria (<0.2 g/gCr: 83.3%, <0.3 g/gCr: 82.1%, <0.5 g/gCr: 78.3%, <1.0 g/gCr: 72.8%). In the multiple regression model, the number of clinical criteria achieved was significantly associated with renal progression. Moreover, the model including SBP, HbA1c, urinary protein, and triglyceride; e.g. intensive treatment, showed the strongest relationship (odds ratio 0.65, 95% confidence interval 0.53-0.82, p < 0.001). To prevent renal dysfunction progression, treatment with renin-angiotensin system inhibitor and statin are not sufficient in CKD patients. Intensive treatment of SBP, HbA1c, urinary protein, and triglyceride is essential. Even in patients with low eGFR, exacerbation of renal injuries was prevented with intensive treatment.