Progression of CKD form pre-dialysis : natural course, risk factors, and outcomes

Abstract

Chronic kidney disease (CKD) is a progressive disease associated with increased morbidity and mortality. Different therapeutic interventions in the course of CKD are shown to be effective in slowing or preventing disease progression. This thesis focused on the progression of CKD from pre-dialysis to dialysis. The main conclusions of this thesis are: A positive first-degree family medical history of diabetes mellitus and cardiovascular disease is associated with increased mortality in the first year of pre-dialysis care, but not with decline of kidney function. Second, increased serum phosphorus levels, but not serum calcium levels, are associated with a shorter dialysis-free survival in the first two years of pre-dialysis care. Furthermore, increased phosphorus levels at start of pre-dialysis care are associated with the rate of decline of kidney function. Third, late referral to pre-dialysis care is associated with increased mortality in the first year of dialysis. Fourth, the decline of kidney function is constant in the period of one year before dialysis initiation until two to four months of dialysis therapy. After that period, the rate of decline of kidney function decreases. Finally, in contrast to common believe, in dialysis patients, cardiovascular and noncardiovascular mortality are equally increased.