KDIGO Recommendations for Slowing CKD Progression

New Orleans—Several measures for prevention of progression of chronic kidney disease (CKD) were included in 2012 recommendations in guidelines from Kidney Disease Improving Global Outcomes. The measures include blood pressure control, use of renin-angiotensin system inhibitors (RASi), and dietary advice.

There are few data on whether the recommendations are followed in current nephrology practice. Benedict Stengel, MD, and colleagues recently performed an analysis of baseline data (2013-2017) from the CKDOPPS (Chronic Kidney Disease Outcomes and Practice Patterns) study. DOPPS was a prospective cohort study of adult patients with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 from national samples of nephrology clinics in Brazil, France, Germany, and the United States.

The outcomes of interest were success rates in achieving recommended measures by albuminuria category (using either spot or 24-hour urinary albumin or protein equivalent) or eGFR, by country. Results were reported during a poster session at Kidney Week 2017 in a poster titled Current Nephrology Practices for Slowing CKD Progression—The Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDOPPS).

Median age ranged from 67 years in Brazil to 77 years in Germany. Albuminuria was routinely measured in 42% of patients in Brazil, 44% of patients in Germany, and 43% of patients in the United States, and in 89% of patients in France (where the measurement was requested per study protocol). In all countries, proteinuria was more routinely measured than albuminuria.
Percentages of patients with blood pressure <140/90 were lower at higher unilateral proteinuria and higher in the United States and Germany compared with Brazil and France. There were no differences in use of RASi by albuminuria level by country; RASi use was lower at lower eGFR in Brazil, Germany, and the United States.

Patients with low eGFR were slightly more likely to receive dietary advice, particularly for salt intake. It was not common for patients in any country to have a consultation with a dietician.
“Monitoring albuminuria as recommended is not a standard practice in nephrology. Blood pressure control and RASi use vary substantially by country, and expert dietary advice remains poor across participating countries. The effects on clinical outcomes, and reported variation in incidence of kidney failure by country, will be evaluated during follow-up,” the researchers said.
Source: Stengel B, Tu C, Lange C, et al. Current nephrology practices for slowing CKD progression—the chronic kidney disease outcomes and practice patterns study (CKDOPPS). Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 4, 2017, New Orleans, Louisiana.