Study: CKD Not Likely to Progress to ESKD Over 5 Years

Although current guidelines stress the importance of renal replacement therapy, patients with chronic kidney disease (CKD) are highly unlikely to progress to end-stage kidney disease (ESKD) over 5 years, according to recent research from the United Kingdom.

Primary care providers typically manage patients with CKD, yet guidelines do not focus on primary care treatment and instead emphasize the risk of ESKD and the need for renal replacement therapy.
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To better understand CKD in the primary care setting, the researchers recruited 1741 patients with stage 3 CKD who were treated at 32 primary care practices in Derbyshire, United Kingdom.

Patient visits occurred at baseline, year 1, and year 5, at which patients were assessed for disease progression using Kidney Disease: Improving Global Outcomes criteria; disease remission, defined as estimated glomerular filtration rate of >60 mL/min and urine albumin-to-creatinine ratio <3 mg/mmol; and all-cause mortality.

At the 5-year follow-up, only 0.2% of patients had developed ESKD, 17.7% experienced disease progression, 19.3% had met remission criteria, and 34.1% had stable CKD.

Patients who had achieved remission at baseline and year 1 were highly likely to achieve remission at year 5 compared with those without remission at baseline and year 1.

“Management of CKD in primary care should focus principally on identifying the minority of people at high risk of adverse outcomes, to allow intervention to slow CKD progression and reduce cardiovascular events,” the researchers concluded.

“Efforts should also be made to identify and reassure the majority who are at low risk of progression to ESKD. Consideration should be given to adopting an age-calibrated definition of CKD to avoid labelling a large group of people with age-related decline in GFR and low associated risk as having CKD.”

—Amanda Balbi

Reference:

Shardlow A, McIntyre NJ, Fluck RJ, McIntyre CW, Taal MW. Chronic kidney disease in primary care: outcomes after five years in a prospective cohort study [published online September 20, 2016]. PLoS Med. http://dx.doi.org/10.1371/journal.pmed.1002128.