title: Independent Role of Underlying Kidney Disease on Renal Prognosis of Patients with Chronic Kidney Disease under Nephrology Care.
abstract: Primary kidney disease is suggested to affect renal prognosis of CKD patients; however, whether nephrology care modifies this association is unknown. We studied patients with CKD stage I-IV treated in a renal clinic and with established diagnosis of CKD cause to evaluate whether the risk of renal event (composite of end-stage renal disease and eGFR decline ≥ 40%) linked to the specific diagnosis is modified by the achievement or maintenance in the first year of nephrology care of therapeutic goals for hypertension (BP ≤ 130/80 mmHg in patients with proteinuria ≥ 1 50 mg/24h and/or diabetes and ≤ 140/90 in those with proteinuria <150 mg/24h and without diabetes) anemia (hemoglobin, Hb ≥ 11 g/dL), and proteinuria (≤ 0.5 g/24h). Survival analysis started after first year of nephrology care. We studied 729 patients (age 64 ± 15 y; males 59.1%; diabetes 34.7%; cardiovascular disease (CVD) 44.9%; hypertensive nephropathy, HTN 53.8%; glomerulonephritis, GN 17.3%; diabetic nephropathy, DN 15.9%; tubule-interstitial nephropathy, TIN 9.5%; polycystic kidney disease, PKD 3.6%). During first year of Nephrology care, therapy was overall intensified in most patients and prevalence of main therapeutic goals generally improved. During subsequent follow up (median 3.3 years, IQR 1.9-5.1), 163 renal events occurred. Cox analysis disclosed a higher risk for PKD (Hazard Ratio 5.46, 95% Confidence Intervals 2.28-10.6) and DN (1.28,2.99-3.05), versus HTN (reference), independently of age, gender, CVD, BMI, eGFR or CKD stage, use of RAS inhibitors and achievement or maintenance in the first year of nephrology care of each of the three main therapeutic goals. No interaction was found on the risk of CKD progression between diagnostic categories and month-12 eGFR (P=0.737), as with control of BP (P=0.374), Hb (P=0.248) or proteinuria (P=0.590). Therefore, in CKD patients under nephrology care, diagnosis of kidney disease should be considered in conjunction with the main risk factors to refine renal risk stratification.
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Provenzano
authors.affiliation: Medical Statistics Unit School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Borrelli
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Garofalo
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pacilio
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Liberti
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Adelia
authors.initials: A
authors.lastname: Sagliocca
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.affiliation: Nephrology Division School of Medicine-Second University of Naples, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009398:Nephrology; D011379:Prognosis; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D051436:Renal Insufficiency, Chronic / Q000473:pathology / Q000503:physiopathology*; D016019:Survival Analysis