Kidney disease, chronic progression factors

List the risk factors for progression of chronic kidney disease (CKD). 

McClellan WM, Flanders WD. Risk factors for progressive chronic kidney disease. J Am Soc Nephrol 2003 14(7 Suppl 2) S65-70. 

Deicher R, Horl WH. Anaemia as a risk factor for the progression of chronic kidney disease. Curr Opin Nephrol Hypertens 2003 12 139—143. 

For diabetic patients with chronic kidney disease (CKD) stages 1-11 (Creatinine clearance betwem normal and 60 mL/min/1.73 m ), stage-independent actions such as control of cardiovascular risk factors (hypertension, hyperlipidemia, and smoking), avoidance of drug toxicity and diagnostic injury, control of progression, and reduction of proteinuria are essential. 

Iron has been implicated as a key factor in tubular cell damage in a variety of acute and chronic renal insults (Nankivell et al. 1992), and the tubulointerstitial injury, an invariant finding in the chronically diseased kidney, may be the major determinator of subsequent nephron loss and progressive renal failure (Alfrey 1994). 

Anemia is also an independent risk factor for progression of chronic renal failure. The anemia of CKD is, in most patients, normocytic and normochromic, and is due primarily to reduced production of erythropoietin (EPO) by the kidney (a presumed reflection of the reduction in functioning renal mass), low iron stores and shortened red cell survival. In 40%, it could be corrected by iron replacement. Early initiation of EPO therapy in patients with CKD and mild to moderate anemia significantly slowed down the progression of renal disease and delayed the need for renal replacement therapy. The target level of hemoglobin is llOg/1 [10],... 

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