What are the Risk factors for progression of Chronic kidney disease?
Progression of kidney disease is defined as a loss of GFR over time and includes the need to initiate renal replacement therapy.
Factors that affect progression are GFR and albuminuria categories, absolute amounts of albuminuria, the cause for the underlying kidney disease, hypertension, age, race/ethnicity, obesity, exposure to nephrotoxic agents, episodes of AKI, and laboratory parameters such as hemoglobin, serum albumin, calcium, phosphate, and bicarbonate.
The progression of chronic kidney disease (CKD) can be influenced by several risk factors. These are typically divided into modifiable and non-modifiable categories. Here’s a breakdown:
Modifiable Risk Factors (can be managed or treated):
- Hypertension (High Blood Pressure):
Poorly controlled blood pressure accelerates kidney damage. - Diabetes (especially poorly controlled):
A leading cause of CKD progression due to damage to the glomeruli. - Proteinuria (Excess Protein in Urine):
A key predictor of CKD progression; higher levels worsen outcomes. - Smoking:
Associated with faster decline in kidney function. - Obesity:
Contributes to hypertension, diabetes, and increased proteinuria. - Use of Nephrotoxic Drugs:
NSAIDs (like ibuprofen), certain antibiotics, and contrast agents can worsen kidney function. - Poorly Controlled Lipids (Dyslipidemia):
May contribute to cardiovascular disease and kidney damage. - Acute Kidney Injury (AKI):
Recurrent or severe AKI can lead to or worsen CKD. - Diet and Hydration:
High salt, high protein intake, and poor hydration can stress kidneys.
Non-Modifiable Risk Factors (cannot be changed):
- Age:
Kidney function naturally declines with age. - Family History of Kidney Disease:
Genetic predispositions (e.g., polycystic kidney disease). - Ethnicity:
Higher risk in African American, Hispanic, Asian, and Native American populations. - Low Birth Weight or Prematurity:
Associated with lower nephron number and higher CKD risk later in life.
Other Contributing Factors:
- Anemia: Common in CKD and may contribute to faster progression.
- Hyperphosphatemia and Hyperparathyroidism: Disturbances in mineral metabolism.
- Metabolic Acidosis: Can accelerate kidney damage if untreated.
