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Kidney Week

Abstract: PO0511

Defining Criteria for CKD Stage 3 Patients Nephrology Referral: An Analysis Focused on CKD Progression and Mortality Risk

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Goncalves, Luis Falcao, Hospital Beatriz Angelo, Loures, Lisboa, Portugal
  • Fernandes, Adriana, Hospital Beatriz Angelo, Loures, Lisboa, Portugal
  • Raimundo, Mario Rui, Hospital Beatriz Angelo, Loures, Lisboa, Portugal
Background

The high prevalence of CKD and its increasing awareness by primary care clinicians. While the referral of CKD stage 4 and 5 to a nephrology clinic is undisputable, the need for stage 3 patients referral is still subject to debate. Our objective was to investigate baseline characteristics of CKD stage 3 patients associated with subsequent CKD progression, in order to help determine which patients should be referred at this stage.

Methods

Retrospective analysis of all patients referred to a nephrology clinic over 6 years. We included CKD stage 3 patients with at least 36 months of follow-up or 24 of follow up with more than 3 serum creatinine determinations. CKD progression was defined by one of the following: 1) an eGFR decline superior to 5mL/min/year; 2) creatinine duplication; 3) The need for chronic RRT. Baseline covariates included demographics, comorbid conditions and laboratory values. Univariate and multivariate analysis were employed to determine independent predictors of CKD progression and mortality.

Results

Out of the 3008 patients 594 (19.8%) met the inclusion criteria (median age: 71.9 years; 63.8% male). Median follow-up was 4.9 years (IQR 2.2). 133 (22.4%) met the criteria for CKD progression and 110 (18.6%) died. CKD progression was associated with higher proteinuria (405.7 vs 65.5mg/gr, p<0.001), Diabetes (60.9 vs 45.3%, p=0.002), CHF (40.6 vs 28.7%, p=0.009), Anemia (68.0 vs 44.7%, p<0.001), higher diuretic use (48.9 vs 34.1%, p=0.002) and mortality (40.9 vs 12.2%, p<0.001)
Albuminuria over 300 mg/gr [Odds ratio (OR) 3.57, 95% CI 2.20 - 5.80] and Anemia (OR 1.97, 95% CI 1.20 – 3.22) were associated with CKD progression. The independent predictors of mortality were: CKD progression (OR 4.49, 95% CI 2.69-7.50), Older age (OR per 1 year increase 1.03, 95% CI 1.01-1.05), presence of CHF (OR 1.75, 95% CI 1.03-2.98), presence of Hyperkalemia at first consultation (OR 2.12, 95% CI 1.00 – 4.52) and Anemia (OR 1.93, 95% CI 1.03 - 3.62).

Conclusion

Patients with macroalbuminuria and anemia at first consultation are at increased risk for rapid CKD stage 3 progression. In this group, patients with CHF, anemia and hyperkalemia (even at first consultation) have a higher risk of mortality.
This study may be useful and help us in guiding which CKD stage 3 patients should be referred to a nephrology clinic.