CKD Nonprogressors:A Commonly Underrecognized Syndrome?

Introduction: NKF-KDOQI 2002/KDIGO 2005 guidelines established CKD stages 1-5 to optimize CKD care. Is CKD progression inevitable, unless of course managed properly? A population-based cohort study of 129,486 CKD patients found that with advancing age, CKD regression and death were more likely than CKD progression or kidney failure. We describe nonprogression over several years in CKD III and CKD IV, respectively. Case Description: Case 1 - A male liver transplant recipient (July 2018, then aged 49 years), developed post-transplant AKI needing hemodialysis for a week. Pre-transplant creatinine was 0.81 mg/dL, peaked at 7.41 mg/dL, and subsequently stabilized (Figure). It was 1.79 mg/dL (eGFR=44) in May 2024. He was hypertensive in October 2018, and was on Losartan 25 mg daily for 17 months, which was discontinued during a hospitalization with sepsis in March 2020. He has since then not received any CKD-modifying agent. Case 2 - A now 75-yo male patient has a history of AKI on CKD in February 2020 from pyelonephritis, with peak serum creatinine of 5.39 mg/dL, that subsequently improved to 2.76 mg/dL (eGFR=23), 12 days later, hypertension, BPH, morbid obesity (BMI 33.13 kg/m2), and known bilateral renal cysts completed his recent annual Nephrology review in April 2024. Latest creatinine was 2.86 mg/dL (eGFR=22) from April 2024 (Figure). Current medications include Carvedilol, Amlodipine, Torsemide, Baby ASA, Ezetimibe, Finasteride, Tamsulosin and Rosuvastatin. He was never on any other CKD-modifying agent. Discussion: Clearly, there are patients with later stage CKD who remain stable over several years, the so-called CKD non-progressors. Determinants of such CKD stability call for further investigation; the role of pharmacologic agents in such stabilization, in our opinion, remains to be fully truly elucidated.