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Risk Factors for the Progression of Chronic Kidney Disease in Secondary Care Patients

Alison Hale (CHICAS, Lancaster Medical School, Lancaster University)

Chronic Kidney Disease (CKD) is a major global public health problem and is one of the fastest rising major causes of death. For instance in the UK moderate to severe CKD has a prevalence of ~5%. The objective of our study was to identify key risk factors associated with the progression of kidney disease both across and within primary kidney diseases.

We used data collected from secondary care patients who were recruited into the Salford Kidney Study at Salford Royal NHS Foundation Trust, UK. This ongoing study which commenced in 2002 is one of the largest of its kind worldwide, and consists of over 3000 non-dialysis patients with moderate to severe CKD, who are followed-up annually until an end point of either dialysis, kidney transplant or death. The data recorded at follow-up appointments include comorbidities, medications, lifestyle factors, socio-demographic information and biochemical marker measurements.

We used longitudinal modelling, specifically a linear mixed effects model which models population effects alongside patient-specific variability. We identified risk factors within primary disease categories including diabetic nephropathy, glomerulonephritis, hypertensive kidney disease, renovascular disease, polycystic kidney disease and pyelonephritis. The key risk factors for poorer levels of kidney function are biochemical markers and medications, whereas lifestyle factors and physical attributes are less important. Medications play an important role; in particular ACE inhibitors and ARBs are key in diabetic nephropathy and glomerulonephritis, but not in the other diseases. We found that more rapid progression of kidney disease is associated with biochemical markers such as proteinuria. In contrast, medications and comorbidities are not key in rapid disease progression. Our findings have implications for the monitoring and treatment of CKD patients.