Early Detection of CKD Progression in Primary Care: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in the journal Nephrology, Dialysis, Transplantation that examined the risk of rapid progression, kidney failure, hospitalization and death among adults with incident chronic kidney disease (CKD) and clarified the association between predefined risk markers and rapid CKD progression.

The study

For the countrywide study the investigators obtained individual level data from national medical databases, including hospitals and primary care, for adults aged 18 years and older with biochemically defined incident CKD stage G3 between 2017 and 2020. Incident CKD stage G3 was identified based on estimated GFR (eGFR) values calculated from plasma creatinine measurements using the 2009 CKD Epidemiology Collaboration Creatinine equation. Rapid progression of kidney disease was defined as eGFR decline of at least 5 mL/min/1.73 m² per year and kidney failure defined as 2 or more eGFR measurements below 15 mL/min/1.73 m² separated by ≥90 days and/or kidney replacement therapy.

Researchers also evaluated various risk markers associated with rapid progression, including sex, urine albumin–creatinine ratio (uACR), pre-existing diabetes, hypertension and CVD.

The final cohort numbered 133 433 individuals with incident CKD stage G3. The median age at inclusion was 75 years and prevalence of metabolic comorbidities was high: T2D (18%), hypertension (62%), CVD (21%). The median eGFR at inclusion was 56 mL/min/1.73 m².

The findings

Among the cohort, the 3-year risk of rapid progression was 14.6%. Of further and significant concern were findings that the 3-year risk of hospitalization was 53.5% in this population and the risk of death 18.1%.

When the researchers used a heat map to highlight risk of CKD progression based on the investigational risk markers, they found the estimated 3-year risk of rapid decline ranged from 7% (95% CI, 6 - 8) in women with no albuminuria and without either T2D or hypertension/CVD to 47% (95% CI, 41 - 52) in women and 46% (95% CI, 42 - 49) in men with severe albuminuria and both diabetes and hypertension/CVD. Further, among individuals with severe albuminuria, diabetes and hypertension/CVD, nearly half experienced rapid progression within 3 years.

Authors' comment

"The use of easily accessible markers in routine clinical care to identify individuals who are at high risk of rapid progression of CKD may facilitate intensified interventions to prevent complications."

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