Chapter 3
Progression of Chronic Kidney Disease
An Evidence-based Approach to Risk Stratification
Meghan J. Elliott,
Meha Bhatt,
Bryan Ma,
Matthew T. James,
Meghan J. Elliott
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorMeha Bhatt
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorBryan Ma
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorMatthew T. James
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorMeghan J. Elliott,
Meha Bhatt,
Bryan Ma,
Matthew T. James,
Meghan J. Elliott
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorMeha Bhatt
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorBryan Ma
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorMatthew T. James
Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
Search for more papers by this authorBook Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
Chronic kidney disease (CKD) is associated with significant risks of several adverse outcomes, including progression to kidney failure, cardiovascular events, and mortality. This chapter provides an evidence-based approach to risk stratification for the progression of CKD. Although CKD may result from a wide variety of causes, once it is established, common pathological findings of vascular injury, glomerulosclerosis, and tubulointerstitial fibrosis have been described, regardless of the inciting cause. Several commonly ascertained measures have been identified as risk factors or risk modifiers of progression of CKD to kidney failure. The chapter reviews the evidence for these laboratory (estimated glomerular filtration rate and albuminuria), demographic (age, sex, and race), and clinical variables (acute kidney injury, blood pressure, diabetes mellitus, and cardiovascular disease). The best ways to assess patient prognosis use prediction models that combine multiple risk factors to provide estimates of a patient's absolute risk of an outcome.
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