Abstract
BackgroundTargeting the modifiable risk factors may help halt the progression of CKD, thus risk factor analysis is better performed using the parameters in the follow-up. This study aimed to examine the time-dependent risk factors for CKD progression using time-averaged values and to investigate the characteristics of rapid progression group.MethodsThis is a retrospective cohort study enrolling 770 patients of CKD stage 3–4. Time-dependent parameters were calculated as time-averaged values by a trapezoidal rule. % decline of estimated GFR (eGFR) per year from entry was divided to three groups: <10 % (stable), 10–25 % (moderate progression), and ≥25 % (rapid progression). Multivariate regression analyses were employed for the baseline and the time-averaged datasets.ResultseGFR decline was 2.83 ± 4.04 mL/min/1.73 m2/year (8.8 ± 12.9 %) in male and 1.66 ± 3.23 mL/min/1.73 m2/year (5.4 ± 11.0 %) in female (p < 0.001). % decline of eGFR was associated with male, proteinuria, phosphorus, and systolic blood pressure as risk factors and with age, albumin, and hemoglobin as protective factors using either dataset. Baseline eGFR and diabetic nephropathy appeared in the baseline dataset, while uric acid appeared in the time-averaged dataset. The rapid progression group was associated with proteinuria, phosphorus, albumin, and hemoglobin in the follow-up.ConclusionThese results suggest that time-averaged values provide insightful clinical guide in targeting the risk factors. Rapid decline of eGFR is strongly associated with hyperphosphatemia, proteinuria, and anemia indicating that these risk factors should be intervened in the follow-up of CKD.
Highlights
CKD has become a big burden on health and economy in world wide
Time-dependent parameters were calculated as time-averaged values by a trapezoidal rule. % decline of estimated GFR per year from entry was divided to three groups: \10 %, 10–25 %, and C25 %
Baseline estimated GFR (eGFR) and diabetic nephropathy appeared in the baseline dataset, while uric acid appeared in the time-averaged dataset
Summary
CKD has become a big burden on health and economy in world wide. The search for the progression factors of CKD may help solve the problem. A wide variety of studies have explored the prognostic value of certain clinical and biochemical parameters for the renal outcomes of CKD patients [1,2,3]. Sex, age, body height, and original kidney disease cannot be modifiable, blood parameters such as hemoglobin, potassium, phosphorus, and uric acid may vary profoundly by advancement of CKD stage and by optimal treatments in the follow-up period. Risk factors yet to be established are not properly intervened probably because the target range of the risk factors in the follow-up lacks evidence. Taking these unsolved problems into consideration, in the present study, we have decided to use time-averaged values for time-dependent covariates. This study aimed to examine the time-dependent risk factors for CKD progression using time-averaged values and to investigate the characteristics of rapid progression group
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