Progression of chronic kidney disease (CKD) from stage 3 to stage 4 is associated with significantly increased risks of death, acute kidney injury, and hospitalization prior to development of end-stage renal disease (ESRD), a new study suggests.

In a retrospective cohort study of 1,607 patients with CKD stage 3, a team led by David M.J. Naimark, MD, of Sunnybrook Health Sciences Centre in Toronto found that patients who progressed to stage 4 had an approximately 2.6, 2.3, and 1.9 times increased risk of death, acute kidney injury (AKI), and hospitalization for any cause, respectively, in adjusted analyses compared with those who did not progress to stage 4, according to a report in Nephrology Dialysis Transplantation (published online ahead of print).

The researchers defined CKD stage 3 as an estimated glomerular filtration rate (eGFR) of 30–59 mL/min/1.73 m2). They defined progression to CKD stage 4 as 2 independent outpatient eGFR values less than 30 mL/min/1.73 m2.

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The study population had a mean baseline eGFR of 43 mL/min/1.73 m2. Over about 2.7 years, 344 patients (21%) progressed to stage 4, 47 (3%) progressed to ESRD, 143 (9%) were hospitalized with AKI, 188 (12%) died, and 688 (43%) were hospitalized for any reason.