Stage 3 kidney disease
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Understanding Stage 3 Chronic Kidney Disease: Insights from Recent Research
Prevalence and Diagnosis of Stage 3 CKD
Global Prevalence of Undiagnosed Stage 3 CKD
Stage 3 chronic kidney disease (CKD) is often underdiagnosed globally. A multinational observational study, REVEAL-CKD, found that a significant proportion of patients with stage 3 CKD remain undiagnosed. The prevalence of undiagnosed stage 3 CKD was notably high across several countries: 95.5% in France, 84.3% in Germany, 77.0% in Italy, 92.1% in Japan, and around 60% in the USA . Factors associated with undiagnosed CKD included female sex, older age, and the absence of comorbid conditions like diabetes and hypertension.
Importance of Early Diagnosis
Timely diagnosis and treatment of stage 3 CKD are crucial to prevent further kidney function decline and progression to kidney failure. The REVEAL-CKD study emphasizes the need for improved diagnostic practices, particularly in high-risk groups.
Treatment and Management Strategies
Pharmacologic Interventions
The American College of Physicians (ACP) provides several recommendations for managing stage 1 to 3 CKD. They advise against routine screening for CKD in asymptomatic adults without risk factors and recommend against testing for proteinuria in patients already on angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II-receptor blockers (ARBs). For patients with hypertension and stage 1 to 3 CKD, the ACP strongly recommends using either ACEIs or ARBs. Additionally, statin therapy is recommended to manage elevated low-density lipoprotein levels in these patients.
Traditional Chinese Medicine (TCM)
A multicenter randomized controlled trial investigated the efficacy of Traditional Chinese Medicine (TCM) in treating stage 3 CKD. The study found that TCM, both alone and in combination with benazepril, improved estimated glomerular filtration rate (eGFR) and hemoglobin levels with fewer side effects compared to benazepril alone. The combination therapy also showed a higher survival rate and reduced proteinuria.
Urate-Lowering Therapy
A randomized trial assessed the impact of febuxostat, a urate-lowering therapy, on patients with stage 3 CKD and asymptomatic hyperuricemia. The study concluded that febuxostat did not significantly slow the decline in kidney function compared to placebo, although it did reduce the incidence of gouty arthritis.
Cardiovascular and Renal Outcomes
Cardiovascular Risks
Patients with stage 3 CKD are at an increased risk of cardiovascular events. A study from the PREVEND cohort found that individuals with stage 1 to 3 CKD had higher rates of cardiovascular morbidity and mortality compared to those without CKD. The risk was particularly pronounced in patients with higher urinary albumin excretion.
Long-Term Renal Outcomes
The long-term outcomes for patients who recover from acute kidney injury (AKI) but develop stage 3 CKD are concerning. These patients have a higher risk of progressing to more severe CKD stages and increased mortality rates. Additionally, multimorbidity significantly impacts renal outcomes, with patients having multiple comorbidities initiating dialysis earlier than those without.
Self-Management and Support
BRIGHT Intervention
The BRIGHT trial aims to evaluate the effectiveness of a self-management intervention for stage 3 CKD patients. This intervention includes an information guidebook, tailored access to local resources, and telephone support. The trial seeks to improve self-management capacity, health-related quality of life, and blood pressure control.
Conclusion
Stage 3 CKD is a critical phase that requires timely diagnosis and effective management to prevent progression and associated complications. Current research highlights the importance of pharmacologic interventions, the potential benefits of TCM, and the need for comprehensive self-management support. Addressing the high prevalence of undiagnosed CKD and improving diagnostic practices are essential steps toward better patient outcomes.
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