What is the outlook for patients with CKD?

What is the outlook for patients with CKD?

In this article, we will describe what is the outlook for chronic kidney disease (CKD).

Keep track of your kidney data with PKB

Key Points

• Overall the outlook is good. Even though CKD is common (10% of the population), only 1 in 100 develop kidney failure (CKD5) and need dialysis or a kidney transplant
• CKD stages 1-5 are very different, with different outlooks; generally the higher the level of CKD, the worse the outlook
• CKD does not always progress, e.g. CKD1 to 2, CKD2 to 3 etc
• CKD is associated with other long-term diseases that affect longevity, e.g. diabetes, ischaemic heart disease (IHD), and high blood pressure. So CKD patients often has these problems too. This makes it hard to determine what is affecting the outlook for patients with CKD
• Some people with CKD get better, with no evidence of CKD.

This is a complicated subject. We will now explain why, and what we know.

GP long-term study

A UK study from more than 400 general practices in 2010 found the 6% of their patients had CKD. Of these:

• CKD progressed by stage in about 15% of people
• CKD remained stable in about 50% of people
• CKD improved in about 25-30% of people.

Another GP long-term study

A smaller UK 5-year study of 32 general practices of people with CKD stage (1741 patients) found that at the end of the study period disease outcomes were varied:

• About 15% of people had died from all causes, and 5% specifically from cardiovascular causes
• 0.2% of people had developed end-stage renal disease (ESRD) – i.e. the risk was very low
• 20% of people had progressive CKD
• 35% of people had stable CKD
• 20% of people got better with no evidence of CKD.

Note: the study population was predominantly elderly (mean age 72.9 years) and white, so the results may not be directly applicable to the general population.

Kidney Failure Risk Equation (KFRE) – predict dialysis or a transplant

The KFRE is a maths equation that can predict how high or low your chance (risk) of needing dialysis or a transplant (CKD5) within the next 2-year and 5-year.

Results are given as a percent (%) on a scale of less than 1% to 99%.

For example, a result of 1% chance of reaching kidney failure within 2 years, with a 5% chance at 5 years, is considered low.

To calculate KFRE requires this information:

• Age in years
• Gender
• GFR (ml/min)
• Urinary protein (called urinary ACR, or uACR).

Here is an KFRE equation you can use to calculate yours.

Risk of death in end-stage renal disease (ESRD)

An Italian study (n = 27,642) found the five-year survival of people with ESRD from the start of dialysis was 55%. Older age, other serious diseases and diabetes mellitus showed the strongest association with excess mortality.

Average (median) survival (all causes, all ages) is thought to 5 years from the start of dialysis – less in higher risk groups (3 years for diabetes, 2 years for renovascular disease).

All-cause mortality

In a Swedish study of people with CKD stages 4-5 (n = 3040), the risk of mortality was 3.6 compared with age- and sex-matched controls in the general population.

People with CKD are 5-10 times more likely to die than to progress to ESRF. The mortality risk rises with CKD disease progression, and is largely due to cardiovascular disease.

Summary

We have described what is the outlook for chronic kidney disease (CKD).  It is a complicated subject as people with CKD are so variable. CKD can range from a risk factor (like high blood pressure) to a serious disease for which you will need dialysis or a renal transplant.