What are the factors contributing to the progression of renal function in chronic kidney disease

According to epidemiological surveys in some major cities in China, such as Beijing, Shanghai, Guangzhou, and Zhengzhou, the prevalence of chronic kidney disease (CKD) in the general population is 11.8% -13.0%, which is close to the level of developed countries.

Diagnostic criteria for chronic kidney disease: proteinuria, and/or estimated glomerular filtration rate (eGFR)<60ml · min/1.73 ㎡, lasting for ≥ 3 months.

Based on the estimated glomerular filtration rate, chronic kidney disease was classified into stages: Phase 1: ≥ 90ml · min/1.73 ㎡; Phase 2 60-90; Phase 3 30-60; Phase 4, 15-30; 5 periods less than 15.

What are the risk factors for disease progression in chronic kidney disease? Apart from uncontrollable factors such as gender, age, and type of underlying kidney disease, let's take a look at which factors can be intervened.

1. Proteinuria

Research has shown that average proteinuria levels are important risk factors for predicting the progression of kidney disease in patients with stage 1-2 chronic kidney disease and stage 3-5 chronic kidney disease. The more severe the degree of proteinuria, the greater the risk of renal function progression. Moreover, the average proteinuria level during the treatment process has a stronger correlation with renal prognosis than the initial proteinuria level.

2. Blood pressure

On the one hand, as renal function progresses, blood pressure increases, and on the other hand, hypertension can accelerate the deterioration of renal function.

Generally, patients with chronic kidney disease in stages 3-5 will gradually develop hypertension. Controlling blood pressure below 130/80 is considered to meet the standard. A domestic study shows that less than 10% of patients with chronic kidney disease in China have blood pressure that meets the standard.

A recent JASN study showed that some individuals with high blood pressure standards in chronic kidney disease clinics may have hidden hypertension, which is not recognized during the clinic and nighttime sleep. How to better diagnose and treat chronic kidney disease and hypertension is a common problem we are facing.

3. Anemia

A study by CJASN suggests that hemoglobin levels below 105g/L are an important risk factor for end-stage renal failure. The KDOQI guidelines state that all chronic patients should undergo routine hemoglobin monitoring regardless of stage and etiology. Currently, it is recommended that hemoglobin levels in patients with chronic kidney disease should be maintained at 110-130g/L.

A study on mid to late stage kidney disease (stages 3-5) showed that patients with hemoglobin levels greater than 110g/L had a significantly lower risk of renal function progression than those with hemoglobin levels greater than 110g/L. Attention should be paid to improving anemia and protecting kidney function.

4. High protein diet

Chronic kidney disease stage 1-2 can have a normal protein diet of 1.0 grams per kilogram of body weight per day, with high-quality protein as the main ingredient. Stage 3-5 (without dialysis) can have a high-quality low protein diet of 0.6 to 0.8 grams per kilogram of body weight per day.

However, a high protein diet greater than 1.2 grams per kilogram of body weight per day can promote renal function progression.

5. Inducing factors such as infection and fatigue

Basic diseases are uncontrollable, but infection and fatigue can trigger the activity of basic kidney disease. Avoid infection and excessive fatigue (please note that moderate exercise does not increase the risk). If an infection occurs, promptly locate the infected lesion for targeted treatment, especially paying attention to hidden infection areas such as the mouth, anal area, ear, nose, and throat.