Risk factors for progression in patients with KDOQI stage 3 Chronic Kidney Disease (PROGRESER study).

Autor:	Martínez-Castelao A; Servicio de Nefrología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Electronic address: albertomvcastelao@gmail.com., Górriz Teruel JL; Servicio de Nefrología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, Spain. Electronic address: jlgorriz@gmail.com., D'Marco L; Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain. Electronic address: luisgdm@hotmail.com., Garrigós E; Servicio de Nefrología, Hospital Comarcal Francesc de Borja, Gandia, Valencia, Spain. Electronic address: garrigos_enr@hotmail.com., Fernández-Fresnedo G; Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Spain. Electronic address: gemafernandez@humv.es., Espinel Garuz E; Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Electronic address: e.espinel@vhebron.net., Cigarrán Guldris S; Servicio de Nefrología, Hospital da Costa Burela, Burela, Lugo, Spain. Electronic address: secundino.cigaran.guldris@gmail.com., Coloma JA; Servicio de Nefrología, Complejo Hospitalario de Navarra, Pamplona, Spain. Electronic address: jesus.arteaga.coloma@navarra.es., Robles Pérez-Monteoliva NR; Servicio de Nefrología, Hospital Universitario de Badajoz Infanta Cristina, Badajoz, Spain. Electronic address: nrrobles@yahoo.es., Esteban de la Rosa JR; Servicio Nefrología, Hospital Virgen de las Nieves, Granada, Spain., Nieto Iglesias LJ; Servicio Nefrología, Hospital Universitario de Ciudad Real, Ciudad Real, Spain., Ortiz Arduán A; Servicio de Nefrología, Fundación Jiménez Díaz, Madrid, Spain., Navarro-González JF; Unidad de Investigaciónt y Servicio de Nefrología, Hospital Universitario Nuestra Senora de Candelaria, Santa Cruz de Tenerife, Spain. Electronic address: jnavgon@gobiernodecanarias.org.
Jazyk:	angličtina
Zdroj:	Nefrologia [Nefrologia (Engl Ed)] 2024 Sep-Oct; Vol. 44 (5), pp. 689-699. Date of Electronic Publication: 2024 Nov 06.
DOI:	10.1016/j.nefroe.2024.10.002
Abstrakt:	Introduction: The PROGRESER study is a multicentre, prospective, observational, 3-year follow-up study of a cohort of patients with stage 3 chronic kidney disease (CKD) from different nephrology departments of hospitals in the Spanish healthcare system. The primary study objective was to analyse risk factors for CKD progression, identifying possible differences between patients with and without diabetes mellitus (DM). The secondary objective was to analyse if the cardiovascular risk factors were also associated with CKD progression. Patients and Methods: A total of 462 patients (342 men and 120 women; mean age 66.5 ± 11.5 years) were recruited from 25 participating sites in Spain. Clinical, epidemilogical and analytical data were recorder in an electronic registrer each six months. Biological samples were obtained and frozen for a biobank record at baseline and at 18 and 36 months. Results: The initial mean glomerular filtration rate estimated by MDRD and after that reestimated by CKD-EPI was 43.9 ± 7.9 mL/min/1.73 m 2 ; and 29 ± 6,8 mL/min/1,73 m 2 at 3 years. 27.3% of patients had microalbuminuria and 22.5% had macroalbuminuria. Two-thirds of the patients (66.2%) presented renal damage progression according to the study criteria (decrease of more than 15% in eGFR over the baseline value). 38.7% presented a reduction in eGFR ≥ 30%; 20.3% had a reduction in eGFR ≥40%; 10.4% had a reduction ≥50% and 6.9% had a reduction ≥57%. Of the 199 diabetics, 134 (67.3%) suffered renal damage progression. Of the 263 non-diabetics, 172 (65.3%) presented progression (p = 0.456). 27.3% of patients had microalbuminuria and 22.5% proteinuria. The study found that CKD progression to a higher stage was not greater in diabetic compared to non-diabetic patients. Multivariate analysis revealed that the presence of arterial hypertension bordered on significance as a progression factor in non-diabetic patients (p = 0.07), and that, in diabetic patients, lower calcium levels and elevated intact parathyroid hormone levels at baseline were associated with progression. Conclusion: in our study we have not found new factors for progression of renal damage, different from the yet well known traditional factors. DM "per se" was not a differential factor for progression in relation with non DM patients. Progression of renal damage in patients with CKD-3 KDOQI may be interpreted in a multifactorial context. The search for new biomarkers, different from traditional ones, is necessary to establish new therapeutic strategies to prevent the progression of CKD. Competing Interests: Declaration of competing interest A.M.C. has been a consultant and has received honoraria for lectures from AbbVie, Amgen, Boëhringer-Ingelheim, Esteve, Lilly, Merck Sharp Dhôme, Novo-Nordisk, Shire and Vifor-Fresenius Medical Care. J.F.N.G. has been a consultant and has received honoraria for lectures from AbbVie, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Esteve, Genzyme, Lilly, MSD, Novartis, NovoNordisk, Servier, Shire and Vifor Pharma. J.L.G has received honoraria for lectures from AstraZeneca, Boehringer Ingelheim, Janssen, Mundipharma, Novartis, Novonordisk, Otsuka and Vifor Pharma. L.D., E.G., G.F-F., E.E., S.C. J.A., N.R.R, A.O and the rest of the co-authors declare that they have no conflict of interest for this publication. (Copyright © 2024. Published by Elsevier España, S.L.U.)
Databáze:	MEDLINE
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