Chronic kidney disease often benign

Most patients with chronic kidney disease are not at risk of progression and complications, according to a new analysis.

The study was conducted over five years by a team from Nottingham University, UK.

Dr Adam Shardlow and colleagues followed 1,741 patients with chronic kidney disease to see how many required dialysis or kidney transplantation due to end-stage disease.

This group of patients – with stage 3, or ‘mild’ chronic kidney disease and only seen by their primary care doctors – tend to be under-researched.

During the five years of follow up, 14.2% died, mostly of cardiovascular causes. Only 0.2% progressed to end-stage, while 17.7% progressed to a lesser extent. About a third (34.1%) still had stable, stage 3 disease, and 19.3% met the criteria for complete remission.

Full results were published yesterday (20 September) in PLoS Medicine.

Dr Shardlow said: "These results will help clinicians explain the likely outcomes of chronic kidney disease to patients diagnosed with chronic kidney disease in the community. In contrast to common ideas about chronic kidney disease, we have shown the majority people in our cohort were stable over the five-year follow-up period, with a significant minority demonstrating improvement.

"Those with a high risk of progression can be identified using simple measures and referred early to specialist services."

The authors conclude: "Management of chronic kidney disease in primary care should focus principally on identifying the minority of people at high risk of adverse outcomes."

Commenting on the study in an editorial, Dr Guiseppe Remuzzi of the Institute of pharmacology in Milano, Italy, says that the study: " Identifies factors, easily obtained and possibly modifiable, that should heighten surveillance for the minority of subjects with chronic kidney disease Stage 3 who are at risk for progression."

Shardlow, A. et al. Chronic Kidney Disease in Primary Care: Outcomes after Five Years in a Prospective Cohort Study. PLoS Medicine 20 September 2016; doi: 10.1371/journal.pmed.1002128 [abstract]