A Retrospective Study Of Related Risk Factors In The Progression Of Chronic Kidney Disease

Objective:To explore the related factors affecting the progress of patients with chronic kidney disease(CKD)stage 3-4,and provide clinical basis for disease prevention and treatment.Methods:The baseline clinical data of patients with CKD stage 3-4 were retrospectively analyzed.The univariate and multivariate COX regression analysis was used to explore the relevant factors affecting CKD progression.CKD progression was defined as a decrease in GFR grading,with a 25%or more reduction compared to baseline.The average annual decline rate of estimated glomerular filtration rate(eGFR)was analyzed when CKD progressed to end stage renal disease(ESRD).Results:1.A total of 132 patients were included in the analysis,Follow-up time range from 0.7months to 56.5 months.The median follow-up time was 23.4 months,of which the progression group was 17.6months and the non-progression group was 28.9months.There were 95 males(72.0%)and 37 females(28.0%);the average body mass index(BMI)was 24.18±3.28kg/m~2;the average age was 57.7±14.0 years old.Patients with baseline renal function in CKD4 stage were 49 cases(37.1%),CKD3a stage 45 cases(34.1%),and CKD3b stage 38 cases(28.8%).Chronic glomerulonephritis were 47 cases(35.6%),diabetic nephropathy 36 cases(27.3%),hypertension nephropathy 33 cases(25.0%),and other etiology 16 cases(12.1%).2.The median time for progression of renal function in CKD3a was 32.7 months,25.7 months for CKD3b,and 13.2 months for CKD4.There was significant difference between phase CKD3a with CKD 4 phase(P<0.001),phase CKD3b with CKD 4phase(P=0.025)but no significant difference between phase CKD3a and CKD3b(P=0.063).3.Single factor COX regression analysis found that:eGFR range from 15-29ml/min·1.73m~2 was a risk factor for CKD progression,baseline eGFR range from45-59 ml/min·1.73m~2 was a protective factor.However,the effect of CKD stage varies with time.Baseline eGFR range from 45-59 ml/min·1.73m~2 had protective effect on the progression of CKD(RR=0.423,95.0%CI:0.246-0.727,P=0.002)in first 30months,but its protective effect was wear off even an opposite trend after(RR=1.023,95.0%CI:0.246-0.727,P=0.002).Baseline eGFR range from 15-29 ml/min·1.73m~2had a positive effect on the progression of CKD(RR=2.367,95.0%CI:1.609-4.149,P<0.001)in first 29 months but the effect wear off after(RR=1.167,95.0%CI:1.609~4.149,P<0.001).Multivariate COX regression analysis found that:baseline eGFR15-29 ml/min·1.73m~2(RR=2.879,95.0%CI:0.750-4.738,P<0.001)and proteinuria(RR=2.937,95.0%CI:1.390-6.204,P=0.005)are risk factors for the progression of CKD stage 3-4.4.A total of 65(38.8%)patients progressed to ESRD,including 11 cases(16.9%)in CKD3a,15 cases(23.1%)in CKD3b,and 39 cases(60.0%)in CKD4.The median non-dialysis survival time in stage CKD3a was 35.8 months,CKD3b was 32.9months,and CKD4 was 27.6 months.The differences among stage CKD3a,CKD3b and CKD4 were statistically significant(P=0.001,P=0.007),but there was no significant difference between phase CKD3a and CKD3b(P=0.670).5.The average annual eGFR decline rate can be used as a predictor for renal function progressing to alternative therapy(critical point:16.0ml/min·1.73m~2·year;area under ROC curve 0.814,P<0.001).Conclusion:The poorer baseline renal function,the earlier renal function progresses.Baseline eGFR range from 15-29 ml/min·1.73m~2 and patients with proteinuria may be progresses earlier.