Purpose. To explore factors contributing to chronic kidney disease (CKD) progression and change in estimated glomerular filtration rate over time (ΔeGFR) 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. ΔeGFR 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 ΔeGFR 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 ΔeGFR 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
References
[1]
S. Nakai, K. Suzuki, I. Masakane et al., “Overview of regular dialysis treatment in Japan (as of 31 December 2008),” Therapeutic Apheresis and Dialysis, vol. 14, no. 6, pp. 505–540, 2010.
[2]
Clinical Practice Guidebook for Diagnosis and Treatment of Chronic Kidney Disease, Japanese Society of Nephrology, 2009.
[3]
S. Matsuo, E. Imai, M. Horio et al., “Collaborators developing the Japanese equation for estimated GFR: revised equations for estimated GFR from serum creatinine in Japan,” American Journal of Kidney Diseases, vol. 53, no. 6, pp. 982–992, 2009.
[4]
M. Evans, J. P. Fryzek, C. G. Elinder et al., “The natural history of chronic renal failure: Results from an unselected, population-based, inception cohort in Sweden,” American Journal of Kidney Diseases, vol. 46, no. 5, pp. 863–870, 2005.
[5]
A. Serrano, J. Huang, C. Ghossein et al., “Stabilization of glomerular filtration rate in advanced chronic kidney disease: a two-year follow-up of a cohort of chronic kidney disease patients stages 4 and 5,” Advances in Chronic Kidney Disease, vol. 14, no. 1, pp. 105–112, 2007.
[6]
K. Iseki, Y. Ikemiya, C. Iseki, and S. Takishita, “Proteinuria and the risk of developing end-stage renal disease,” Kidney International, vol. 63, no. 4, pp. 1468–1474, 2003.
[7]
Chronic Kidney Disease Prognosis Consortium, “Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis,” The Lancet, vol. 375, no. 9731, pp. 2073–2081, 2010.
[8]
A. S. Go, G. M. Chertow, D. Fan, C. E. McCulloch, and C. Y. Hsu, “Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization,” New England Journal of Medicine, vol. 351, no. 13, pp. 1296–1370, 2004.
[9]
D. S. Keith, G. A. Nichols, C. M. Gullion, J. B. Brown, and D. H. Smith, “Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization,” Archives of Internal Medicine, vol. 164, no. 6, pp. 659–663, 2004.
[10]
T. Sanaka, T. Akizawa, K. Koide, and S. Koshikawa, “Clinical analysis of renoprotective responding patients administrated with oral adsorbent in chronic renal failure secondary to chronic glomerulonephritis,” Therapeutic Apheresis, vol. 7, no. 2, pp. 269–278, 2003.
[11]
Z. Al-Aly and O. Cepeda, “Rate of change in kidney function and the risk of death: the case for incorporating the rate of kidney function decline into the CKD staging system,” Nephron, vol. 119, no. 2, pp. c179–c186, 2011.
[12]
B. M. Brenner, M. E. Cooper, D. De Zeeuw et al., “Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy,” New England Journal of Medicine, vol. 345, no. 12, pp. 861–869, 2001.
[13]
E. J. Lewis, L. G. Hunsicker, W. R. Clarke et al., “Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes,” New England Journal of Medicine, vol. 345, no. 12, pp. 851–860, 2001.
[14]
K. Konishi, S. Nakano, S. I. Tsuda, A. Nakagawa, T. Kigoshi, and D. Koya, “AST-120 (Kremezin) initiated in early stage chronic kidney disease stunts the progression of renal dysfunction in type 2 diabetic subjects,” Diabetes Research and Clinical Practice, vol. 81, no. 3, pp. 310–315, 2008.
[15]
T. Shoji, A. Wada, K. Inoue et al., “Prospective randomized study evaluating the efficacy of the spherical adsorptive carbon AST-120 in chronic kidney disease patients with moderate decrease in renal function,” Nephron, vol. 105, no. 3, pp. c99–c107, 2007.
[16]
A. Owada, M. Nakao, J. Koike, K. Ujiie, K. Tomita, and T. Shiigai, “Effects of oral adsorbent AST-120 on the progression of chronic renal failure: a randomized controlled study,” Kidney International, vol. 51, no. 63, pp. S188–S190, 1997.
[17]
T. Akizawa, Y. Asano, S. Morita et al., “Effect of carbonaceous oral adsorbent on the progression of CKD: A multicenter, randomized, controlled trial,” American Journal of Kidney Diseases, vol. 54, no. 3, pp. 459–467, 2009.
