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Renal function can improve at any stage of chronic kidney disease
Lise Weis1, Marie Metzger2, Jean-Philippe Haymann3
1Department of Nephrology, AP-HP, Hôpital Tenon, Paris, France.
Insights
Kidney function can improve in chronic kidney disease (CKD) patients, even in advanced stages. Achieving therapeutic targets and having lower albuminuria are key factors associated with this improvement.
Area of Science:
- Nephrology
- Internal Medicine
- Renal Medicine
Background:
- Chronic kidney disease (CKD) typically involves progressive renal function decline.
- Improvement in glomerular filtration rate (GFR) has been observed in hypertensive nephropathy, but its occurrence in other nephropathies and stages is unclear.
- Identifying characteristics of patients who experience GFR improvement is crucial for understanding CKD progression and management.
Purpose of the Study:
- To investigate the possibility of GFR improvement in patients with various types of nephropathy and across different CKD stages.
- To identify patient features and therapeutic target achievement associated with sustained GFR improvement.
- To explore the relationship between GFR improvement and CKD-related metabolic complications.
Main Methods:
- Analysis of 406 patients from the NephroTest cohort with at least 3 mGFR measurements over 2 years.
- Classification of patients into 'improvers' (sustained mGFR increase) and 'nonimprovers' based on expert review of GFR trajectories.
- Comparison of baseline characteristics, therapeutic target achievement (blood pressure, proteinuria, RAS blockers), and metabolic complications between improvers and nonimprovers.
Main Results:
- 15.3% of patients showed sustained GFR improvement (median slope +1.88 ml/min/year).
- Improvers had various nephropathies (excluding diabetic glomerulopathy and polycystic kidney disease) and lower urinary albumin excretion rates.
- Improvers achieved more therapeutic targets and had fewer CKD-related metabolic complications and less vitamin D deficiency compared to nonimprovers.
Conclusions:
- Sustained GFR improvement is achievable in CKD patients, including those in stages 4-5.
- GFR improvement is associated with achieving therapeutic targets and is linked to a reduction in metabolic complications.
- The findings suggest that proactive management and adherence to treatment targets may facilitate renal function recovery in certain CKD populations.
Introduction:
Even though renal function decline is considered relentless in chronic kidney disease (CKD), improvement has been shown in patients with hypertensive nephropathy. Whether this can occur in any type of nephropathy and at any stage is unknown as are the features of patients who improve.
Methods:
We identified 406 patients in the NephroTest cohort with glomerular filtration rates (mGFR) measured by (51)Cr-EDTA clearance at least 3 times during at least 2 years of follow-up. Individual examination of mGFR trajectories by 4 independent nephrologists classified patients as improvers, defined as those showing a sustained mGFR increase, or nonimprovers. Twelve patients with erratic trajectories were excluded. Baseline data were compared between improvers and nonimprovers, as was the number of recommended therapeutic targets achieved over time (specifically, for systolic and diastolic blood pressure, proteinuria, and use of renin angiotensin system blockers).
Results:
Measured GFR improved over time in 62 patients (15.3%). Their median mGFR slope was +1.88[IQR 1.38, 3.55] ml/min/year; it was -2.23[-3.9, -0.91] for the 332 nonimprovers. Improvers had various nephropathies, but not diabetic glomerulopathy or polycystic kidney disease. They did not differ from nonimprovers for age, sex, cardiovascular history, or CKD stage, but their urinary albumin excretion rate was lower. Improvers achieved significantly more recommended therapeutic targets (2.74±0.87) than nonimprovers (2.44±0.80, p<0.01). They also had fewer CKD-related metabolic complications and a lower prevalence of 25OH-vitamin-D deficiency.
Conclusion:
GFR improvement is possible in CKD patients at any CKD stage through stage 4-5. It is noteworthy that this GFR improvement is associated with a decrease in the number of metabolic complications over time.
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