Risk Factors for Progression in Patients with Early-stage Chronic Kidney Disease in the Japanese Population

Abstract

Objective Chronic kidney disease (CKD) is an important worldwide health problem. The incidence of endstage renal disease (ESRD) is increasing

Syndrome of rapid-onset end-stage renal disease: a new unrecognized pattern of CKD progression to ESRD

“…This picture is in antithesis to current models of CKD progression and reno-protection, which depend to a very large extent on the premise of a slow albeit relentless but predictable loss of eGFR, the development of micro-albuminuria, then the progression to macro-albuminuria, subsequent progression to overt proteinuria, then the doubling of serum creatinine, and an ultimate but still predictable and inexorable progression to ESRD. 4,[17][18][19]23 This previously unrecognized clinical syndrome, SORO-ESRD, is common among older patients. Our hypothesis received a very strong boost by a recent report by Ishani et al who examined the risk of ESRD among over 200,000 Medicare seniors aged >67 years.…”

“…Current models and concepts of reno-protection, as already noted, depend on the foundation of a slow albeit relentless but predictable loss of eGFR, the development of microalbuminuria, then macro-albuminuria, then overt proteinuria, then doubling of serum creatinine, and ultimately the still predictable and inexorable progression to ESRD. 4,[17][18][19]23 These stepped changes in kidney structure and function have been largely predicated and blamed on the actions of angiotensin II, hence the premise of reno-protection by RAAS blockade (ACE inhibitors, ARBs, etc.). Indeed, the clinical measurement and documentation of levels of proteinuria in patients followed up by nephrologists, the documentation of degrees of proteinuria reductions in the large RAAS blockade trials, 9-16 the use of proteinuria reduction as surrogates of reno-protection, [9][10][11][12][13][14][15][16] all have strong foundations in this traditional concept or model of predictive CKD progression to ESRD.…”

“…[9][10][11][12][13][14][15][16] Current literature on ESRD outcomes in chronic kidney disease (CKD) is primarily predicated on a theory of a smooth continuous progressive loss of glomerular filtration rate (GFR) with several publications over the decades describing CKD progression to ESRD in terms of annual rates of GFR decline in mL/ min/1.73 m 2 /year or as mean annualized estimated glomerular filtration rate (eGFR) slopes. 4,[17][18][19] Furthermore, in the large renin-angiotensin-aldosterone system (RAAS) blockade reno-protection trials, the efficacy of reno-protective strategies has been adjudged on the basis of how much more or less the rate of doubling of serum creatinine or decline of GFR was impacted by different intervention strategies. 11,15,16 The question remains whether, in fact, we really understand the natural history of CKD with particular reference to progression to ESRD and/or death outcomes.…”

Decreased renal function in overweight and obese prepubertal children

“…Since kidney diseases with reduced renal mass are believed to mimic what happens in obesity, representing the clinical translation of the experimental hyperfiltration models (25), the increased levels of these substances, promoted in the proinflammatory and pro-oxidant setting of obesity, might partially explain the kidney impairment observed. Moreover, it is important to recognize that some of the conditions associated with obesity might also act to reduce renal function, such as high blood pressure (and glomerular hypertension), hyperlipidemia, insulin resistance, hyperleptinemia and increased sympathetic activity and overactivation of renin-angiotensin system (2,26). Another factor contributing to explain the impact of obesity on the kidney might be the reduced nephron mass associated with conditions like being born small for gestational age or preterm (27).…”

Evidence of the syndrome of rapid onset end-stage renal disease (SORO-ESRD) in the acute kidney injury (AKI) literature – preventable causes of AKI and SORO-ESRD – a call for re-engineering of nephrology practice paradigms

“…According to most nephrologists, the classic view of chronic kidney disease to end-stage renal disease (CKD-ESRD) progression is the consensus opinion of a predictable, orderly, methodical, linear, progressive, relentless and time-dependent decline in renal function, with progressively increasing serum creatinine, leading through CKD stages I, II, III, IV and V, and ultimately and inexorably ending up in ESRD and the need for renal replacement therapy (RRT) [1][2][3][4][5] ( Figure 1). Conversely, in opposition, the syndrome of rapid onset end-stage renal disease (SORO-ESRD), which we first described in 2010, is the sudden, unanticipated, precipitate and yet irreversible ESRD rapidly following AKI superimposed in a CKD patient with an a priori otherwise stable CKD [6][7][8][9][10][11][12] ( Figure 1).…”