Combination Treatments to Slow CKD Progression

Background: Chronic Kidney Disease (CKD) is often caused by health conditions such as diabetes and hypertension, as well as risk factors such as obesity and smoking. Optimal strategies for personalized treatment and behavioral modifications are the key to prevention and management of CKD. We present an analysis of CKD progression patterns and investigate their association with different risk factors and treatments. Methods: The following data were abstracted from Chronic Renal Insufficiency Cohort (CRIC): GFR (CKD-EPI), age, BMI, smoking status, hypertension, proteinuria, diabetes, and the use of antidiabetic agents, beta blockers, ACE inhibitors, and ARB’s. We estimated the GFR slope in 960 subjects with 11 or more measurements and performed unsupervised clustering to discover distinct GFR trends (slopes). We then performed local linear regression modeling to establish which treatment combinations were statistically (p < 0.05) associated with slowing GFR decline. Results: Data in figure 1 confirm that the most rapid GFR decline is associated with the highest prevalence of diabetes, hypertension, and proteinuria. Treatment combinations associated with improving GFR are: ARB or beta blocker – in rapid decline group, ARB and beta blocker – in slow decline group, beta blocker and ACE inhibitor or beta blocker and ARB – in stable group, combination of all three agents – in increasing group. We found no statistically significant effect of using anti-diabetic agents. Conclusion: Optimal treatment combinations may help slow down the CKD progression. Our results confirm the detrimental effect of hypertension and diabetes on CKD progression and identify which antihypertensive agent combinations could be most effective in slowing down kidney function decline, based on patient risk stratification. Acknowledgments: CRIC data were provided by NIDDK Central Repository, a program of the National Institute of Diabetes and Digestive and Kidney DiseasesDistribution of comorbidities and treatments stratified by GFR slope: HTN - hypertension, BMI - body mass index, DIAB - diabetes, SMOKE - smoking status, PROTEIN - proteinuria, ANTIDIAB - diabetes medication, ACE INH - ace inhibitor, ARB - angiotensin receptor blocker, BETA BLK - beta blocker.