Factors of Poor Prognosis Associated with Chronic Kidney Disease by Stage in Ambulatory Patients: A Cross-sectional Study

Background: Mexico has a high prevalence of chronic kidney disease (CKD) but limited information about the early stages of CKD and their clusters of poor prognosis factors (PPF) such as hyperuricemia, electrolyte abnormalities or comorbidities.

Objective: To assess the prevalence of PPF by CKD stages in ambulatory patients.

Methods: A cross-sectional study with 1772 adult patients with CKD that attended the Nephrology Outpatient Clinic. PPF data is reported as adjusted OR (95% confidence interval) (CI).

Results: Mean age was 56.2 ± 15.8 years. Kidney Replacement Therapy (KRT) was reported in 12% of the patients. Type 2 diabetes mellitus (T2DM), age >50 years and male gender were the PPF associated with all CKD stages. The PPF in CKD 2 and 3a hyperuricemia OR 3.4 (2.02,6.0) and 4.4 (2.5,7.6), and hypertension OR 1.8 (1.01,3.4) and 2.3 (1.2,4.3) respectively. In CKD 3b were hyperuricemia OR 5.1 (3.1,8.6), hypertension OR 2.7 (1.5,4.9) and hyperkalemia OR 3.4 (1.5,7.6). For CKD 4, 5 without KRT and 5 were hyperuricemia OR 7.02 (4.1,11.8), 13.5 (7.4,24.6), 3.9 (2.2-6.9), hypertension OR 3.4 (1.9,6.1), 3.4 (1.9,6.1), 3.8 (2.1,7.1), and hyperkalemia 2.9 (1.3,6.3), 7.9 (3.6,17.3), 8.7 (3.9,19.3), respectively. Anemia was important for CKD 5 without KRT and 5 with OR of 5.7 (3.09,10.6) and 8 (4.2,15), respectively.

Conclusions: This is the largest study of Mexican patients with CKD; most of them without KRT. Patients had multiple modifiable PPF. Early and comprehensive management of PPF could prevent or delay progression to KRT. Treatment of associated PPF should be a priority, as it could make a significant difference both for CKD progression and its subsequent cardiovascular risk.