**3.1 Risk factors for development of CKD**

### **1. Susceptibility Factors**

14 Chronic Kidney Disease

respectively. The NICE CKD guideline also suggested adding the suffix *p* to the stages in proteinuric patients.It has generally been assumed that the majority of patients with CKD stages 3B to 5 eventually progress to ESRD. A Canadian study showed the natural history of CKD stages 3 and 4 to be variable and reflecting the patient's risk factor profile.Stage 4 may present with hyperkalemia or problems with salt and water retention. The kidneys are no longer able to adjust to abrupt changes in sodium, potassium and fluid intake (or loss). Prior to initiation of renal replacement therapy, the patient's appetite may decrease, accompanied by weight loss and a decrease in the serum albumin. In CKD clinics, with patients seen at frequent intervals, the goal is to initiate dialysis before the patient becomes malnourished.

Stage Description GFR (ml/min/1.73m2)

3B 30 - 44

1 Kidney damage with normal or ↑ GFR ≥ 90 2 Kidney damage with mild ↓ GFR 60-89 3 Moderate ↓ GFR 3A 45 – 59

4 Severe ↓ GFR 15-29

Table 1. Stages of CKD.

**3. Risk factors** 

formula and MDRD formula.

cardiovascular and renal injury.

5 Kidney Failure < 15 (or dialysis) The suffix p to be added to the stage in patients with proteinuria > 0.5 g/24h

**Cockcroft-Gault formula:** <sup>140</sup> 0.85

transplantation. Who are these patients? What risk factors do they have?

**Modification of diet in renal disease (MDRD) formula:** 

1.154 0.203 *GFR SCr A* 186 . *ge i* 1.212 0.742 *f black if female*

Two commonly used formulas to calculate creatinine clearance are the Cockcroft-Gault

It is estimated that by 2030,more than 2,000,000 Americans will need dialysis or

Low birth weight individuals with a decreased number of nephrons, the elderly population losing 1 ml/min/year after the age of 30 and Americans of African descent with hypertension, are several groups of individuals at risk.About one half of patients starting dialysis in America have diabetes mellitus, with hypertension the second largest group. Autoimmune disorders, infections, kidney stones, cystic kidneys and toxins/medications round out the list. Microalbuminuria may indicate systemic endothelial dysfunction and may be associated with a prothrombotic state. Insulin resistance is mediated in part by aldosterone; blocking the receptor attenuates

The risk factors can be classified as those that increase the risk of development of kidney disease and those that increase the risk of adverse outcomes associated with CKD. The

72 *Age Mass Kgs if female GFR*

*Serum Cr*

A susceptibility factor is one that increases susceptibility to kidney damage following exposure to an initiation factor. An ideal study design to study these factors would be to identify a population of individuals who are free of kidney disease and are exposed to an initiation factor and follow them for a period of time.
