Optimal CKD Follow-Up Intervals Proposed
Longer follow-up intervals than recommended in current guidelines may be appropriate for patients with chronic kidney disease..
Investigators have proposed optimal follow-up intervals for different stages of chronic kidney disease (CKD) based on their findings from a prospective observational study of 2682 patients with CKD.
These intervals shorten with increasing CKD stages, from 6 months for stage 3A to 3.4, 2.0, and 1.2 months for stages 3B, 4, and 5, respectively, Keita Kirano, MD, of Kyoto University Graduate School of Medicine in Kyoto, Japan, and colleagues reported in Clinical and Experimental Nephrology.
“These estimates are longer than those recommended by the relevant guidelines, and they serve as a reference for nephrologists to select appropriate follow-up intervals for their patients,” Dr Kirano's team concluded.
These guidelines include the Kidney Disease: Improving Global Outcomes (KDIGO) international guidelines and the Evidence-based Practice Guideline for the Treatment of CKD of the Japanese Society of Nephrology. The recommended follow-up intervals are based on a consensus among experts that renal function decreases more rapidly as CKD severity increases, Dr Kirano and colleagues noted.
The investigators defined optimal follow-up intervals according to the time of occurrence of a composite renal event (a 50% increase in baseline creatinine level or the start of treatment for end-stage renal disease, whichever occurred first) in 0.1% of the patients in the various CKD subgroups. Of the 2682 patients, 913 (34%) experienced a composite renal event. Of these, 29 (10.5%) had stage 3A, 151 had stage 3B (16.3%), 429 had stage 4 (41%), and 304 (70.9%) had stage 4 CKD.
“Our findings suggest that renal function at the initial examination is the most relevant factor for determining the interval for additional renal function assessments,” they wrote.
Hirano K, Kobayashi D, Kohtani N, et al. Optimal follow-up intervals for different stages of chronic kidney disease: a prospective observational study. Clin Exp Nephrol. 2019; published online ahead of print.