Chronic Kidney Disease (CKD): Risk Factors for Progression

00:01 Okay.

00:02 So let's now talk about risk factors that can progress our patients.

00:06 Now this is important, we've diagnosed our patient, they have chronic kidney disease, They're sitting here before us, we need to know what can we do to mitigate some of those factors that are going to put them at an increased risk of progressing and potentially moving towards end-stage renal disease.

00:22 Things that we need to really pay attention to are things like proteinuria.

00:26 Do they have in particular greater than 1 gram of protein per day.

00:30 That's a very very high risk that that patient is going to progress.

00:34 Is that patient hypertensive despite the fact that we're trying to control their blood pressure that actually puts them at an increase in risk of developing chronic kidney disease that's Progressive.

00:45 The type of underlying disease is also important if I have a diabetic they almost always progress.

00:51 Despite the fact that we try our best efforts to control them.

00:54 That's a highly Progressive disease and polycystic kidney disease.

00:58 Remember we talked about Autosomal dominant polycystic kidney disease.

01:01 That's a genetic disease for which at this point in time we have no cure those are so those patients are certainto progress.

01:08 African-American race is also important we talked about that APOL1 Allelic variant that puts people at risk of developing Progressive disease so it's something that we have to keep in mind.

01:17 And believe it or not gender has a role in this as well.

01:20 Men progress more than women.

01:23 So we need to think about that as well.

01:25 And then obesity.

01:26 So typically people over with a BMI greater than 30 have an increase in glomerular capillary pressure and that also puts that patient at risk for progression.

01:38 Having lipid abnormalities dyslipidemia is also a risk factor for progression.

01:43 Smoking, I think that's a no-brainer for most of us.

01:45 We know patients should quit smoking but patients who continue to smoke will have progression.

01:51 And high phosphorus levels.

01:52 We just went over bone mineral disease having high phosphorus that's not controlled is certain to progress our patients as well as developing metabolic acidosis, and it's interesting because as we supplement those patients with sodium bicarb, we actually see that appears to slow progression probably because of a reduction in tubulointerstitial inflammation from the bicarb.

02:15 So a couple of other risk factors that we need to think about are having a high protein diet.

02:19 So what's important to think about when it comes to high protein diets, I'm not talking about normal patients who don't have chronic kidney disease.

02:26 These are patients who have underlying chronic kidney disease.

02:30 And it's that high protein actually can increase GFR it causes vasodilation and then hyperfiltration and when you have that hyperfiltration you increase your glomerular capillary pressure causing glomerular capillary hypertension and because of they don't have appropriate autoregulation that can lead to progressive glomerulus sclerosis, so that's how high protein diets in patients who have underlying chronic kidney disease can progress their disease.

02:55 Again, I want to just really illustrate a point here that if you have a patient in the absence of chronic kidney disease, we don't have data at this point in time that high protein diets are going to accelerate or cause chronic kidney disease in that population.

03:08 And then finally hyperuricemia, so there's data emerging that lowering your egg acid levels may have slowed the rate of GFR loss.

03:15 But I also want to illustrate another point here.

03:18 The jury is still out.

03:19 We have some randomized controlled trials that are ongoing right now that are really going to definitively answer that question.

03:23 So stay tuned.