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Titolo	Timing of Onset of CKD-Related Metabolic complications
Autore	Olivier Moranne,± Marc Froissart,±§_ Jerome Rossert,§ Cedric Gauci,± Jean-Jacques Boffa,* Jean Philippe Haymann,*±± Mona Ben M?rad,±± Christian Jacquot,§ §§ Pascal Houillier,±§_ Benedicte Stengel, Bruno Fouqueray,** and the NephroTest Study Group - INSERM Unit 780 and Universite´ Paris-Sud, Faculty of Medicine, IFR69, Villejuif, and Departments of ±Physiology and §§Nephrology, Georges Pompidou European Hospital, Assistance Publique-Ho? pitaux de Paris, §Faculty of Medicine, Universite´ Paris Descartes, _INSERM U 872, Departments of Nephrology and ±±Physiology, Tenon Hospital, Assistance Publique-Ho? pitaux de Paris, *Universite´ Pierre et Marie Curie, Faculty of Medicine, and INSERM U702, Paris, France
Referenza	J Am Soc Nephrol 2009; 20: 164-171
Contenuto	Chronic kidney disease (CKD) guidelines recommend evaluating patients with GFR _60 ml/min per 1.73 m2 for complications, but little evidence supports the use of a single GFR threshold for all metabolic disorders. We used data from the NephroTest cohort, including 1038 adult patients who had stages 2 through 5 CKD and were not on dialysis, to study the occurrence of metabolic complications. GFR was measured using renal clearance of 51Cr-EDTA (mGFR) and estimated using two equations derived from the Modification of Diet in Renal Disease study. As mGFR decreased from 60 to 90 to _20 ml/min per 1.73 m2, the prevalence of hyperparathyroidism increased from 17 to 85%, anemia from 8 to 41%, hyperphosphatemia from 1 to 30%, metabolic acidosis from 2 to 39%, and hyperkalemia from 2 to 42%. Factors most strongly associated with metabolic complications, independent of mGFR, were younger age for acidosis and hyperphosphatemia, presence of diabetes for acidosis, diabetic kidney disease for anemia, and both male gender and the use of inhibitors of the renin-angiotensin system for hyperkalemia. mGFR thresholds for detecting complications with 90% sensitivity were 50, 44, 40, 39, and 37 ml/min per 1.73 m2 for hyperparathyroidism, anemia, acidosis, hyperkalemia, and hyperphosphatemia, respectively. Analysis using estimated GFR produced similar results. In summary, this study describes the onset of CKD-related complications at different levels of GFR; anemia and hyperparathyroidism occur earlier than acidosis, hyperkalemia, and hyperphosphatemia.
Data	09.03.2009

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