Archives of the Balkan Medical Union (Sep 2019)
The association of kidney stress test with water salt loading with estimated glomerular filtration rate decline in patients with chronic kidney disease stage 1-3
Abstract
Introduction. Kidney Disease Outcomes Quality Initiative (KDIGO) Group proposes the estimated glomerular filtration rate (eGFR) and albuminuria rate for a combined risk of clinical outcomes in patients with chronic kidney disease (CKD). However, the decline rate of eGFR can vary independently of the baseline eGFR. The objective of the study was to improve the prognostic efficacy in chronic kidney disease (CKD) stage 1-3 due to new significant factors of CKD progression detected by renal stress test via the water-salt loading with 0.5 % sodium chloride solution, at a rate of 0.5% of the body weight. Material and methods. In a single-centre prospective study, during 3-year follow-up period, from January 2016 to December 2018, 108 patients with CKD stage 1-3 (a, b) were examined. There were two groups: patients with rapidly progressive CKD whose eGFR throughout one-year follow-up decreased by 3 ml/min/1.73 m2 and more (59 patients), and the group with a stable CKD, whose eGFR throughout one-year follow-up did not decrease or has decreased by less than 3 ml/min/1.73 m2 (49 patients). Results. No relationship between the renal functional reserve, stimulated GFR and a decline in eGFR throughout the year was found. The change in urine creatinine on the background of the water-salt loading was positively correlated with changes in eGFR throughout the year. Spearman’s correlation coefficient was rs 0.4 (p-0.02). The OR of decline in eGFR by more than 3 ml/min/1.73 m2 throughout the year, with a decrease in urine creatinine level by more than 2 mmol/L, was 4.7 (95 % CI 1.9-12.0). Conclusions. Improving the functionality of the renal stress test via the water-salt loading by measuring urine creatinine can help to identify the high-risk group for disease progression.
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