WASHINGTON—Rapid kidney function decline leads to a higher risk of premature death compared with patients whose kidney function decline is mild, according to a study published online Oct. 14 in the Journal of the American Society of Nephrology (JASN).
Studies that have taken a snapshot of chronic kidney disease (CKD) indicate that the condition increases one’s risk of premature death, but in reality, kidney disease is dynamic and changes over time.
A recent study by Ziyad Al-Aly, MD (Saint Louis Veterans Affairs Medical Center) and his colleagues indicates that a patient who has experienced rapid kidney function decline has a higher risk of dying prematurely than a patient whose kidney function decline was mild.
To come to this conclusion, the researchers studied 4,171 patients with early kidney disease, following them for approximately nine years. They found that 38 percent of the patients did not experience any kidney function decline, while 10 percent, 28 percent, and 24 percent experienced mild, moderate, and severe kidney function decline over time, respectively.
The investigators also identified various risk factors for severe kidney function decline, including black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease.
Patients who experienced severe kidney function decline over time had a 54 percent increased risk of dying during the study period compared with patients with mild kidney function decline.
These findings show that the rate of kidney function decline has a significant impact on a kidney disease patient’s risk of dying prematurely.
“The take home message from the study is that it matters how you got here," said Al-Aly. All patients with kidney disease have a higher risk of dying early, but rapid development of kidney disease portends poorer overall prognosis and carries an even higher risk of premature death. Therefore, physicians should carefully assess patients’ change in kidney function over time and focus on strategies to protect their kidney function.
In an accompanying editorial, Csaba Kovesdy, MD (Salem Veterans Affairs Medical Center and the University of Virginia) noted that the study could have some immediate and far-reaching clinical implications. It “raises awareness about the importance of the progressive nature of CKD and suggests that the incorporation of slopes of estimated glomerular filtration rate [a measure of kidney function] into the evaluation of CKD could lead to a refinement in risk stratification that may have important practical benefits,” he wrote.
