Chronic kidney disease (CKD) : natural history and impact of socio-economic factors as well as health service provisions

• Main Author: Hossain, Mohammad Parvez
• Published: University of Sheffield 2011
• Subjects: 614.5961
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.574569

Background: Worldwide, the rapidly rising prevalence of chronic kidney disease (CKO) and the impact of adverse outcomes including endstage renal disease (ESRO) on renal replacement therapy (RRT) and cardiovascular rnorbiditv and mortalitv are an increasing public health burden. Aims: To investigate the natural history of CKO; the predictors of progression and regression of CKO in a clinic population, including demographic, clinical and socio-economic factors and explore the implications for health services of variations in prevalence and severity Methods: A retrospective cohort was established and data collected using clinic records and postal questionnaires Models were developed of the predictors of outcomes in CKO patients attending a single clinic and by using geographical information system (GIS), to investigate socioeconomic inequalities in terms of workload for primary care at area level in Sheffield, UK Results: In a cohort of 918 patients, 22% of the patients had regression 44~'O remained stable, only 34% experienced progression. This was despite of the vast majority presenting with late stages of CKO; mainly stages 3 and 4. In the multivariare model. beyond the expected predictors that reflected reversal of traditional risk of progression such as lower baseline SBP and lower proteinuria, we observed that lower baseline. eGFR and serum phosphorous, higher haemoglobin and not using ACEi/ARB were independent predictors of regression CKO patients from the most deprived areas experienced a higher proportion of progression as well as a faster rate of progression of CKD compared to those lived in the least deprived areas (lMO quintile 5 44% progression and 13%) rapid progression; IMD quintile 1. 13% progression and 6% fast progression). Furthermore, we found those who living in more deprived areas, a strong independent risk for presentations with heavy proteinuria and progression and rapid progression of CKD. We also found, there was significant clustering of ('KO patients referred to the hospital in the most deprived areas Both the prevalence of CKO and associated conditions (OM, HTN, CHO, and Obesity) and case load per general practitioner (GP) were significantly higher in deprived areas. Conclusions: Predictors of progression and regression need to be better understood in order to inform prognosis and clinical practice Health commissioners and providers need to ensure that high quality services for early identification and active management of CKO are available, particularly in relatively deprived areas.