Chronic renal failure risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]


It is important to identify patients at risk for developing chronic renal disease, even in patients with a normal serum creatinine levels. Chronic renal failure, requiring dialysis or organ transplant, can often be prevented with early detection and treatment.

Risk factors

  • The kidneys are able to recover from many insults without necessary progression to CKD and end-stage renal disease (ESRD).
  • Several factors have been shown to increase the risk of progression.
  • The most studied model of progression to CKD is diabetic nephropathy (DN).
  • Studies have linked the risk of progression to CKD in DN to the following risk factors:
    • Hypertension
    • Poorly controlled diabetes
    • High urinary protein excretion (proteinuria/albuminuria).[1][2][3][4]
  • Other risk factors:
    • Chronic NSAID use[5]
    • Cigarette smoking in diabetic patients.[6]
    • Pre-existing cardiovascular disease including:
      • Stroke
      • Angina
      • Claudication
      • Transient ischemic attack
      • Coronary angioplasty or bypass
      • Recognized or silent myocardial infarction[7]


  1. Leehey DJ, Kramer HJ, Daoud TM, Chatha MP, Isreb MA (2005). "Progression of kidney disease in type 2 diabetes - beyond blood pressure control: an observational study". BMC Nephrol. 6: 8. doi:10.1186/1471-2369-6-8. PMC 1180831. PMID 15985177.
  2. Staples A, Wong C (2010). "Risk factors for progression of chronic kidney disease". Curr Opin Pediatr. 22 (2): 161–9. doi:10.1097/MOP.0b013e328336ebb0. PMC 2948868. PMID 20090523.
  3. Breyer JA, Bain RP, Evans JK, Nahman NS, Lewis EJ, Cooper M; et al. (1996). "Predictors of the progression of renal insufficiency in patients with insulin-dependent diabetes and overt diabetic nephropathy. The Collaborative Study Group". Kidney Int. 50 (5): 1651–8. PMID 8914032.
  4. Hovind P, Rossing P, Tarnow L, Smidt UM, Parving HH (2001). "Progression of diabetic nephropathy". Kidney Int. 59 (2): 702–9. doi:10.1046/j.1523-1755.2001.059002702.x. PMID 11168952.
  5. Murray MD, Black PK, Kuzmik DD, Haag KM, Manatunga AK, Mullin MA; et al. (1995). "Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients". Am J Med Sci. 310 (5): 188–97. PMID 7485222.
  6. Orth SR, Schroeder T, Ritz E, Ferrari P (2005). "Effects of smoking on renal function in patients with type 1 and type 2 diabetes mellitus". Nephrol Dial Transplant. 20 (11): 2414–9. doi:10.1093/ndt/gfi022. PMID 16046507.
  7. Elsayed EF, Tighiouart H, Griffith J, Kurth T, Levey AS, Salem D; et al. (2007). "Cardiovascular disease and subsequent kidney disease". Arch Intern Med. 167 (11): 1130–6. doi:10.1001/archinte.167.11.1130. PMID 17563020.

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