Kidney Disease: Warning Sign of its Own

Chronic kidney disease with or without diabetes and hypertension may indicate ESRD and death risks

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Kidney disease patients have a higher risk of death and kidney failure than others. It was thought that adding high blood pressure or diabetes to the mix boosted these risks. But kidney disease alone may be enough.

Even in people without high blood pressure or diabetes, chronic kidney disease itself may be a strong sign of the risk of death and end-stage renal disease (complete or near-complete kidney failure), according to two recent studies.

"Get regular check-ups if you have kidney disease."

In many cases, chronic kidney disease is accompanied by diabetes and high blood pressure, or hypertension. High blood pressure is the most common of these two conditions among people with kidney disease. In two separate studies, researchers at Johns Hopkins University examined the risk of death and end-stage renal disease in patients with chronic kidney disease.

In the first study, Bakhtawar K. Mahmoodi, MD, PhD, from the Johns Hopkins Bloomberg School of Public Health and University Medical Center Groningen in the Netherlands, and colleagues examined these risks in kidney disease patients with and without high blood pressure.

They found low kidney function and high urine protein (a sign of kidney damage) were associated with the risk of heart-related death and death from all causes in kidney disease patients with and without high blood pressure.

Similarly, low kidney function and high urine protein were associated with the development of end-stage renal disease, whether or not patients had high blood pressure.

The association with death was stronger in patients without high blood pressure than in those with high blood pressure. Among those without high blood pressure, the hazard ratio for death was 1.77, compared to 1.24 among those with high blood pressure.

A hazard ratio explains how often an event happens in one group versus another. A hazard ratio of more than 1.0 means one group has a higher risk of that event - in this case, death from all causes. The association with end-stage renal disease was not different between those with and those without high blood pressure.

In the second study, Caroline Fox, MD, of the Framingham Heart Study and National Institutes of Health, and colleagues looked at the links between kidney disease and the risks of death and end-stage renal disease in kidney disease patients with and without diabetes.

Overall, kidney disease patients with diabetes had a higher risk of heart-related death, death from all causes and end-stage renal disease, compared to patients without diabetes. Generally, the risk of death was 1.2 to 1.9 times higher among those with diabetes than those without diabetes.

When patients were grouped by kidney function and urine protein levels, the relative risks of death and end-stage renal disease were fairly similar whether or not patients had diabetes.

"Chronic kidney disease should be regarded as at least an equally relevant risk factor for [death] and end-stage renal disease in individuals without hypertension as it is in those with hypertension," said Dr. Mahmoodi.

The research was supported by the US National Kidney Foundation and National Institutes of Health among others. The studies were published in The Lancet. No conflicts of interest were disclosed.

Reviewed by: 
Review Date: 
September 25, 2012
Last Updated:
December 3, 2012