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Abstract
Background: The state of kidney damage or reduced kidney function lasting three months or longer, known as chronic kidney disease (CKD), is both progressive and irreversible. An emerging challenge is the identification of potential factors associated with rapid renal function decline, which would form the basis for the development of strategies to prevent or retard disease progression, and reduce complications, thereby improving disease outcomes. We are clearly facing an urgent public health problem in the country and worldwide.
Objectives: To identify the risk factors associated with decline in renal function in patients with CKD
Materials and Methods: This study was done in the Department of Medicine of GMC & Hamidia hospital Bhopal. It was a hospital based prospective observational study in which 50 diagnosed CKD patients (stage 3 and 4) were studied. All the patients fulfilling the inclusion criteria were subjected to detailed clinical history, systemic examination, routine investigation, SUA measurement and echocardiography for determination of LVH. Measurement of glomerular filtration rate (GFR) and GFR estimating equations are important tools for identification and association of risk factors for CKD progression. The results thus obtained from clinical/laboratory examinations were analysed with the ECHO findings to determine the correlation with progression in CKD. The categorical data was compared by using chi-square test. P value of < 0.05 is considered as significant.
Results: According to the KDIGO 2012 clinical practice guidelines for the evaluation and management of CKD, a rapid decline in renal function was defined as a sustained decline in eGFR of > 5 mL/min per 1.73 m2 per year. In CKD, lower level of kidney function at presentation, higher levels of proteinuria, and hypertension are known markers for a more rapid decline in GFR. Anemia and other reported risk factors from the pre-genomic era have need for further study and validation. Genome-wide association studies have identified genetic loci which have provided novel genetic risk factors for CKD progression.
Conclusion: Potential risk factors contributing to a rapid decline in renal function include ethnic/genetic and demographic factors, lifestyle and health behaviors, metabolic and biochemical abnormalities, cardiovascular functional factors, smoking habits, increased glycated hemoglobin levels, obesity, albuminuria, anemia, low serum magnesium levels, high serum phosphate levels, vitamin D deficiency, elevated systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity values, retinopathy, and cardiac autonomic neuropathy.