2023 年 2 巻 1 号 p. 16-22
Background: Progressive chronic kidney disease, which necessitates dialysis, results in inability to maintain renal homeostasis. Although drugs are available, maintenance of residual renal function is challenging, and the estimated glomerular filtration rate (eGFR) declines rapidly. Age, sex, primary disease of renal failure, blood pressure, urinary protein, anemia, and access preparation for dialysis affect the decline in eGFR during this period.
Methods: We investigated 428 incident dialysis patients who received nephrology care for >6 months before dialysis initiation. We retrospectively compared age, primary disease (diabetic vs. non-diabetic kidney disease), blood pressure, serum hemoglobin levels, urinary protein levels, renin-angiotensin system (RAS) inhibitor, diuretics, vitamin D use and preparation of access at initiation to determine their association with the decline in eGFR over 6 months before dialysis initiation.
Result: The decline in eGFR was significantly associated with age (<60 years), sex (male), without access preparation, hypertension (6 months before and at initiation), renin-angiotensin system inhibitor use (6 months prior), nephrotic-range proteinuria, and vitamin D use.
We observed no significant differences in the primary disease (diabetic vs. non-diabetic kidney disease), RAS inhibitor use and hemoglobin levels at initiation. RAS inhibitors are also effective in CKDG1 to G4, whereas they are not effective in CKD with advanced G5.
Multivariate analysis showed that eGFR decline was significantly correlated with sex, vascular access preparation, and urinary protein levels.
Conclusion: Renal function preservation is challenging in patients with progressive chronic kidney disease accompanied by increased urinary protein levels. Regardless of renin-angiotensin system inhibitor use, renal function was better preserved in women with strict blood pressure control and vascular access preparation before dialysis initiation.
