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Epidemiology of CKD Regression in Patients under Nephrology Care

Silvio Borrelli1, Daniela Leonardis2, Roberto Minutolo1

  • 1Nephrology Division at Second University of Naples, Naples, Italy.

Plos One
|October 14, 2015
PubMed

Insights

Chronic Kidney Disease (CKD) regression, defined by improved kidney function, occurs in 27.6% of patients. This outcome is linked to better kidney prognosis, particularly in earlier stages, and is associated with low proteinuria and blood pressure.

Area of Science:

  • Nephrology
  • Renal Medicine
  • Clinical Research

Background:

  • Chronic Kidney Disease (CKD) regression is an infrequent renal outcome, typically observed in early stages and linked to increased mortality.
  • The prevalence, prognosis, and clinical correlates of CKD regression in nephrology care settings are not well-defined.

Purpose of the Study:

  • To determine the prevalence, clinical correlates, and prognostic significance of CKD regression in patients under nephrology care.
  • To investigate factors associated with CKD regression and its impact on End-Stage Renal Disease (ESRD) and overall mortality.

Main Methods:

  • A multicenter prospective study involving 1418 patients with established CKD (eGFR: 60-15 ml/min/1.73m²) across 47 Italian outpatient clinics.
  • CKD regression was defined as an estimated Glomerular Filtration Rate (eGFR) increase (ΔGFR ≥0 ml/min/1.73 m²/year) over 18-24 months.
  • Outcomes assessed included ESRD and all-cause mortality, analyzed using multivariate regression and spline models.

Main Results:

  • CKD regression was identified in 391 patients (27.6%), with no association found between regressor status and CKD stage.
  • Low proteinuria was the primary factor associated with CKD regression (48% likelihood). Additional predictors included lower systolic blood pressure, higher BMI, and absence of autosomal polycystic disease (PKD).
  • Regressors had a 72% lower risk of ESRD (HR: 0.28) but no significant difference in mortality risk compared to non-regressors. The ESRD risk reduction was attenuated in advanced CKD stages.

Conclusions:

  • CKD regression is observed in approximately one-fourth of patients receiving nephrology care and is associated with favorable renal prognosis, especially in earlier stages.
  • Key correlates of CKD regression include low proteinuria, controlled blood pressure, and the absence of PKD.
  • CKD regression portends a better renal prognosis with no increased risk of mortality.

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