%0 Journal Article
%T Usefulness of Change in Estimated Glomerular Filtration Rate as a Predicting Factor of Progression of Chronic Kidney Disease
%A Kunimi Maeda
%A Chieko Hamada
%A Satoshi Horikoshi
%A Yasuhiko Tomino
%J ISRN Nephrology
%D 2013
%R 10.5402/2013/351364
%X Purpose. To explore factors contributing to chronic kidney disease (CKD) progression and change in estimated glomerular filtration rate over time (¦¤eGFR) as a risk factor in predialysis patients under multidisciplinary managements. Methods. Among 113 CKD patients, eGFR, serum creatinine, total protein, albumin, urea nitrogen, uric acid, calcium, inorganic phosphate, total cholesterol, urinary creatinine, urinary protein (UP), hemoglobin A1c, hemoglobin, and hematocrit were analyzed. Results. ¦¤eGFR analysis in the first six months presented a positive slope (remission group) in 43 patients (38%) and a negative slope (no-remission group) in 70 patients (62%). Three-year dialysis-free rate was 89.4% in the remission group and 39.3% in the no-remission group, with a significant difference ( ). To explore factors contributing to dialysis initiation by stepwise Cox regression, baseline eGFR (HR 0.706, ) and ¦¤eGFR in the first six months of treatment (HR 0.075, ) were identified. To investigate factors affecting remission and no remission by stepwise logistic regression, age (odds ratio 1.06, ) and UP excretion (odds ratio 1.223, ) were identified. Conclusion. Monitoring of ¦¤eGFR and UP is not only useful in suppressing CKD 3 progression, but also in deciding strategies to achieve remission in individual patients. 1. Introduction In Japan, the number of patients with chronic kidney disease (CKD) shows a trend of annual increase and has reached 13.3 million as estimated by the Japanese Society of Nephrology. In other words, 1 in 9 adults is affected by CKD, showing a great impact of this disease on the population. In addition, the number of patients initiated on dialysis therapy continues to increase at a rate of 10,000 a year, reaching approximately 280,000 at the end of 2009 and has become an important medicoeconomic and social issue [1]. The Japanese Society of Nephrology tackled the establishment of standard treatment and dissemination of estimated glomerular filtration rate (eGFR) for the Japanese, which form the basis of CKD guidelines, and published the Clinical Practice Guidebook for Diagnosis and Treatment of Chronic Kidney Disease 2009 [2]. However, the current therapies cannot be regarded as optimal, and further studies of multidisciplinary treatment incorporating various modalities are required. With the previous background, further promotion of the use of eGFR as a simple indicator of the disease condition and practice of treatment based on evidence obtained from clinical studies are necessary. To investigate the relationship between the change in
%U http://www.hindawi.com/journals/isrn.nephrology/2013/351364/