Wang Z1,2, Zhang J1,2, DIWAN V1,2, CAMERON A1,3, VENUTHURUPALLI S1,4, HEALY H1,2,5, Hoy W1,2
1NHMRC CKD.CRE and CKD.QLD, Brisbane, Australia, 2Faculty of Medicine, University of Queensland, Brisbane, Australia, 3Queensland Health, Brisbane, Australia, 4Kidney Health Service, Toowoomba Hospital, Toowoomba , Australia, 5Kidney Health Service, RBWH, Brisbane, Australia
Aim: To examine progression of eGFR in CKD patients.
Background: CKD.QLD is a research platform for chronic kidney disease (CKD). Subjects are recruited with informed consent from renal specialty practices in Queensland’s public health system.
Methods: Patients with documented eGFR data at consent and at one-year follow-up were included in the study. Demographic and clinical data were gathered from medical records. CKD progression was defined as decrease of eGFR of >30% from baseline.
Results: 5,184 patients were included. Males comprised 55%. Age at consent was 17-99 yrs, median 68.9 yr, and the proportions of primary renal diagnoses (PRD) were renovascular disease (RV) (30.8%), diabetic nephropathy (DN) (24.4%), glomerulonephritis (GN) (12.6%), genetic renal diseases (GRD) (5.6%), unknown renal diagnoses 10.2% and others 16.5%. Fouty-two percentage of patients had macro-proteinuria. Indigenous Australians accounted for 8.3% (n=430). Frequencies of diabetes and hypertension were 47.6% and 80.6%, respectively. Percentages with prior admissions for AKI, CVD and anaemia (primary and associated admissions recorded by ICD-codes in the registry) were 25.4%, 22.7% and 18%, respectively. 12.3% of CKD patients (n=637) had progression at one year follow up. Factors correlated with progression (Odds Ratios, ORs,) were 3.2 (p<0.001) for macro-proteinuria/albuminuria, 1.8 (p<0.05) for both AKI and anaemia admissions, 1.9 (p=0.02) and 1.5 (p=0.086) for those with GRD and DN, respectively (GN as a reference group)), 1.6 (p=0.036) for Indigenous status and 1.3 (p=0.187) for CVD admissions. Age, gender, diabetes and hypertension were not significantly associated with CKD progression.
Conclusions: Macro-proteinuria /albuminuria, prior AKI, anaemia, GRD, DN, Indigenous status and arguably CVD admissions were independently associated with CKD progression. Characteristics of those who did not progress are of special potential importance.
Dr Wang is a Senior Research Fellow/data manager and biostatistician working at the center for chronic disease at UQ. His research fields involve epidemiology and public health of chronic diseases among Australian Indigenous people, and chronic kidney disease survey and registry in CKD.QLD. He obtained Ph.D in QUT and has engaged in the NHMRC post-doctorial research fellowship between 2006-2009.