García de Vinuesa S
Hospital General Universitario Gregorio Marañón, Madrid.
Nefrologia. 2008;28 Suppl 3:17-21.
The natural history of most chronic kidney diseases (CKD) indicates that glomerular filtration gradually declines over time, progressing to more advanced stages of kidney failure. Since the publication of the first studies by the Modification of Diet in Renal Disease (MDRD) Study Group, numerous factors have been identified that can accelerate this progression. Some are dependent on the etiology, but other are common to all and may accelerate progression of kidney disease: Non-modifiable progression factors for CKD: - Etiology of kidney disease - Degree of initial kidney function - Gender - Age - Ethnicity/Other genetic factors - Birth weight Modifiable progression factors for CKD: - Proteinuria - High blood pressure - Poor glycemic control in diabetes - Smoking - Obesity - Metabolic syndrome/Insulin resistance - Dyslipidemia - Anemia - Metabolic factors (Ca/P, uric acid) - Use of nephrotoxic drugs. Therapeutic intervention on these factors has shown that it reduce the rate of progression of CKD (Strength of Recommendation A).There is no clear evidence that correction of these factors slows CKD (Strength of Recommendation C), although it has been shown to have a beneficial effect on cardiovascular risk at other levels.
大多数慢性肾脏病（CKD）的自然病程表明，肾小球滤过率会随着时间逐渐下降，进而发展至更晚期的肾衰竭阶段。自肾病饮食改良（MDRD）研究小组发表首批研究以来，已确定了许多可加速这一进程的因素。有些因素取决于病因，但其他因素则是所有患者共有的，可能会加速肾病进展：CKD不可改变的进展因素：- 肾病病因- 初始肾功能程度- 性别- 年龄- 种族/其他遗传因素- 出生体重CKD可改变的进展因素：- 蛋白尿- 高血压- 糖尿病患者血糖控制不佳- 吸烟- 肥胖- 代谢综合征/胰岛素抵抗- 血脂异常- 贫血- 代谢因素（钙/磷、尿酸）- 使用肾毒性药物。对这些因素进行治疗干预已表明可降低CKD的进展速度（推荐强度为A）。虽然尚无明确证据表明纠正这些因素能减缓CKD（推荐强度为C），但已证明其在其他层面上对心血管风险具有有益作用。
