Risk factors for the rate of progression of chronic kidney disease in secondary care patients

Hale, Alison and Dondelinger, Frank and Diggle, Peter and Kalra, Philip A. (2020) Risk factors for the rate of progression of chronic kidney disease in secondary care patients. Masters thesis, Lancaster University.

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Abstract

Chronic Kidney Disease (CKD) is a major global public health problem and is one of the fastest rising major causes of death. Worldwide moderate to severe CKD has a prevalence of ~11%, whereas in the UK it is ~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; ultimately this could lead to improvements in patient care and a reduction in disease burden. 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 included 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 each of eight primary disease categories including diabetic nephropathy, glomerulonephritis, hypertensive kidney disease, renovascular disease, polycystic kidney disease and pyelonephritis. The key risk factors for lower levels of eGFR 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 including cholesterol and proteinuria. In contrast, medications and comorbidities are not key in rapid disease progression. We recommend future work should include more in-depth studies of each disease category including splitting them into subcategories.