Diagnosis and prevention

Risk factors, causes and outcomes

Most kidney diseases do not have symptoms or findings until later in their course and are detected only when they are chronic. Most causes of CKD are irreversible with a life-long course, and treatment aimed at slowing progression to kidney failure. However, chronicity is not synonymous with irreversibility. In some cases, CKD is entirely reversible, either spontaneously or with treatment, and in other cases, treatment can cause partial regression of kidney damage and improvement in function (e.g. immunosuppressive therapies for glomerulonephritis (GN). Because of the long course of most cases of CKD, patients often have one or more episodes of acute kidney injury (AKI) superimposed upon CKD.1

There are several risk factors to be considered that could become a cause of CKD. Diabetes mellitus and hypertension are the leading causes of CKD, therefore these risk factors should be carefully controlled and monitored in order to allow for an early detection of any sign of kidney damage. Other causes of CKD include inflammatory diseases such as glomerulonephritis, obstructive uropathy: lithiasis, chronic infections: pyelonephritis, and genetic diseases such as polycystic kidney disease.

The different risk factors can be categorised into susceptible, initial, progression and end-stage, depending on the current stage of CKD. However, it is the level of kidney function, regardless of diagnosis, that determines the stage of chronic kidney disease.2

Based on international and European national CKD related guidelines, NephroCare has established the following ranking of risk factors in terms of relevance:

  • Diabetes
  • High blood pressure
  • Heart disease
  • Smoking- Obesity
  • Family history of kidney disease
  • Age1

Early detection is essential, not only to stop the progression of this disease, but also its complications, which are mainly of a cardiovascular nature. In fact, more patients die because of cardiovascular reasons during the progression of their disease compared to those who reach the stage where they require renal replacement therapy.

However, CKD is a modifiable vascular risk factor, provided there is timely intervention to treat its main causes, namely hypertension and diabetes, as long as treatment is still possible.

If these conditions are not acted upon in time, they can lead to End Stage Renal Disease (ESRD) and consequently to the need for renal replacement therapy, as well as significant associated complications.

To inform prognosis, the different factors associated with CKD progression have to be identified.

  1. cause of CKD;
  2. GFR category;
  3. albuminuria category;
  4. other risk factors and comorbid conditions (e.g. age, sex, race/ethnicity, elevated blood pressure (BP), hyperglycaemia, dyslipidemia, smoking, obesity, history of cardiovascular disease, ongoing exposure to nephrotoxic agents, and others)1 

In people with CKD, use estimated risk of concurrent complications and future outcomes to guide decisions for testing and treatment for CKD complications.1

In populations with CKD, group GFR and albuminuria categories with similar relative risk for CKD outcomes into risk categories.1

Based on international and European national CKD related guidelines, there are different outcomes that can be listed, depending on the patient´s specific situation, treatment choice and given options.

  • Kidney insufficiency (Avoidance of progression of RRT)
  • RRT Dialysis
  • RRT Transplantation
  • Death1