Renoprotective interventions efficacy in the late stages of CKD

Abstract

The efficacy of renoprotective interventions in the late stages of chronic kidney disease (CKD) varies significantly from that in the early stages, with approaches in advanced CKD being insufficiently developed and sometimes conflicting. In a small prospective study, we evaluated the effectiveness of intensive follow-up protocol aimed at reducing CKD progression rates, cardiovascular complications, and improving outcomes among 100 patients with CKD3B-5 stages at a single center. This evaluation was compared with the outcomes of standard nephrology care. Positive changes in modifiable parameters resulting from interventions (such as serum albumin, hemoglobin, and standard bicarbonate) or reductions in negative parameters (like serum phosphate, plasma calcium deviation from target range, uric acid, and systolic blood pressure) were independently associated with a comparable reduction in the decrease of glomerular filtration rate (GFR). For the treatment group, the predicted time to reach the need for renal replacement therapy (RRT) from a conditional GFR of 20 ml/min/1.73 m2 was 5 months longer than in the regular follow-up group. The distribution of average GFR at the start of dialysis suggested a late and possibly premature start in the control group, with less than 60% of cases being planned. In contrast, the treatment group always had a planned start.