Prognostic factors in renal disease progression

We have analysed the prognostic factors in progression of renal disease in a prospective study of 613 patients with chronic renal failure with initial creatinine clearance (CrC) between 25 and 70 ml/min (mean 47 +/- 12 ml/min ) during a follow-up period of two years (median 21 +/- 5 months). The most frequent primary renal disease were chronic glomerulonephritis (CGN) chron ic interstitial nephropathies (CIN) renal vascular disease (RVD) diabetic n ephropathy (DN) and polycystic kidney disease (PKD). The mean age was 64 +/ - 14 years. All clinical variables were analysed in a regression model of m ultivariate analysis. We found that baseline CrC, mean arterial pressure (M AP), male sex, and proteinuria were independent variables predicting progre ssion of renal failure. The actuarial renal survival rate tend points: dial ysis, renal transplant or death was lower in those patients with CGN, DN an d PCK. When the renal survival curve was analysed for each individual facto r separately, the log-rank lest showed significantly shorter renal survival in patients with proteinuria greater than 1 g/day than in those with lesse r proteinuria (64% vs 93%, p 0.0001) and patients with severely higher arte rial hypertension (HTN) had worse renal prognosis than those with better co ntrolled HTN though this difference was significant only for patients with uncontrolled systolic blood pressure (SBP). Among patients with proteinuria greater than 1 g/day prognosis was significantly poorer for those with unc ontrolled SEP at all levels of proteinuria. In conclusion, the type of primary renal disease and proteinuria are the ma jor determinants of progression of chronic renal disease but progression wa s also faster in males and those with uncontrolsled SEP. intervention to co ntrol proteinuria and hypertension will probably prevent the rapid progress ion to end stage renal disease in a substantial number of patients.