Renal Outcome of Patients with Chronic Kidney Disease Stage 3-5 under a Multidisciplinary Care Program

摘要

BACKGROUND: A variety of factors are well-recognized as active being active in mediating the progression of chronic kidney disease (CKD). Multidisciplinary care programs (MDCPs) have been shown to be effective in retarding the progression of CKD. However, little is known regarding the progression of CKD in a cohort receiving MDCP. The objectives of this study were to identify factors associated with rapid decline of renal function among a CKD cohort and analyze their outcome.METHODS: CKD patients (stage 3-5) who had been receiving MDCP for at least 24 months were analyzed retrospectively. Their demographic data, co-morbidities and biochemical data were reviewed and collected. Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease Study (MDRD) equation.RESULTS: Of the total 343 patients, 32.1% were CKD stage 3, 23.0% were stage 4 and 44.9% were stage 5. Their mean age was 63.5 years and 36.7% were diabetic. Their baseline GFR was 24.5 mL/min/ 1.73 m2 and biennial GFR change was -3.0 ± 6.4 mL/min/1.73 m~2. We further divided the patients into two groups according to the rate of GFR decline. Patients with biennial GFR change of more than -4 mL/min/1.73 m2 were considered to have rapid progression. 133 patients with rapid progression were then compared with 210 patients with non-rapid progression. Patients with diabetes, hypertension, proteinuria, higher baseline systolic and diastolic blood pressure, and lower albumin level progressed more rapidly. During the follow-up, 30 patients (8.8%) reached the combined endpoint of the study. Logistic regression analysis disclosed that systolic blood pressure and serum albumin level were the independent factors of rapid renal progression. Patients with stage 4 or 5 experienced more rapid progression (stage 4: -3.4 ± 6.8; stage 5: -4.8 ± 5.0 mL/min/1.73 m~2) than those with stage 3 (0.1 ± 6.9 mL/ min/1.73 m~2, P < 0.001).CONCLUSION: The average annual rate of renal function decline in our MDCP cohort was slightly higher than the aging process. Baseline systolic blood pressure and serum albumin level were independent factors of rapid progression among moderate CKD patients under the MDCP.