Progression of chronic kidney disease: ambulatory experience in Santarém - Pará.

Abstract

Chronic kidney disease (CKD) is a growing public health problem. Nevertheless there is a little data about CKD in Brazil, mainly in its non-dialytic stages. To know about demographic, clinical and laboratory features of patients with CKD non-dialytic, and evaluate the impact of these variables on disease progression. A retrospective cohort study comprised of 65 adult patients with stages CKD 2-4, followed-up for 28.24 ± 13.3 months. Mean age was 64.6 ± 12.6 years. The main causes of the CKD were diabetic kidney disease (DRD) (47.7%) and hypertensive nephrosclerosis (34.2%). Most patients were on stage 3 CKD (44.6%) and the minority reached therapeutic targets in control of their co-morbidities, 40% for arterial pressure and 38.7% for glycemic control. The mean annual loss of glomerular filtration rate (GFR) was 3.1 ± 7.3 mL/min/1; 73 m2 (median 1.4 mL/min/1; 73 mL/min/1; 73 m2) 21.5% of patients developed progressive CKD. Diastolic blood pressure (DBP) ≥ 90 mmHg increased 2.7 times the risk of developing progressive CKD (95% CI 1.14 to 6.57; p = 0.0341) as well as systolic blood pressure (SBP) > 160 mmHg (RR = 3.64, 95% CI 1.53 to 8.65; p = 0.0053) and proteinuria (RR = 4.05, 95% CI; 1.55 to 10.56; p = 0.0031). It was also observed higher SBP mean (p = 0.0359) and lower HDL-c median (p = 0.0047) in patients with CKD Progressive. In this study, hypertension and proteinuria were risk factors for evolution with progressive CKD, in spite of the difficult clinical control a minority of patients had the progressive form of CKD.