Prognosis

Chronic kidney disease (CKD) is mostly progressive and leads to end-stage kidney disease and the need for kidney replacement therapy (i.e., dialysis, transplant).

Diabetes and high blood pressure (BP) are the main causes of end-stage kidney disease in adults. In the US in 2020, nearly 808,000 people were living with end-stage kidney disease: 69% on dialysis and 31% with a kidney transplant.[8]

Life expectancy for patients with end-stage kidney disease is significantly reduced. Transplant confers a significant survival advantage over maintenance dialysis therapy, due mainly to reduced risk of cardiovascular death. For patients starting dialysis or receiving a kidney transplant in 2018, 5-year survival was:[190]

  • 40.7% for haemodialysis patients​

  • 42.5% for peritoneal dialysis patients

  • 80.3% for patients receiving a deceased donor transplant

  • 91.5% for patients receiving a living donor transplant.

CKD is a strong cardiovascular risk factor. Patients with CKD are at increased risk of heart disease, heart failure, stroke, and early death. The majority of patients with CKD will die prior to requiring kidney replacement therapy.[191]​ As kidney function declines, complications such as anaemia and hyperparathyroidism develop that may contribute to worsening cardiovascular disease and renal osteodystrophy, respectively. Glycaemic control directly correlates with the development of diabetic kidney disease and the rapidity of progression to end-stage kidney disease.[15] There is evidence that the use of sodium-glucose co-transporter-2 (SGLT2) inhibitors prevents major kidney outcomes (e.g., dialysis, transplantation, or death due to kidney disease) in people with type 2 diabetes.[99] In addition, evidence suggests that SGLT2 inhibitors have a renoprotective benefit for patients regardless of diabetes status.[192][193][194]​​​​​

Optimisation of BP control with the use of ACE inhibitors or angiotensin-II receptor antagonist agents and reduction in proteinuria may slow the rate of progression to end-stage kidney disease and the eventual need for kidney replacement therapy.

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