End-stage Renal Disease


Syndrome of Rapid Onset End-stage Renal Disease Revisited—Observations from Two Chronic Kidney Disease Populations in Two Continents


Macaulay AC Onuigbo, MD, MSc, FWACP, FASN1 and Nnonyelum Onuigbo, MSc2


1. Associate Professor of Medicine, College of Medicine, Mayo Clinic, Rochester, and Regional Director, Mayo Health System Practice-Based Research Network, and Nephrologist/Hypertension Specialist/Transplant Physician, Department of Nephrology, Midelfort Clinic, Mayo Health System; 2. NT Solutions, Eau Claire


Abstract


By most estimates, we have an increasing worldwide end-stage renal disease (ESRD) epidemic—despite over 20 years of intensified renoprotection strategies—including the extensive application of renin-angiotensin-aldosterone system (RAAS) blockade. The consensus is that chronic kidney disease (CKD) progression to ESRD is a continuous, progressive, and predictable loss of estimated glomerular filtration rate over time, inexorably leading to ESRD. We recently described a new, unrecognized syndrome of rapid-onset ESRD (SORO-ESRD). This is the unpredictable and unanticipated accelerated progression from CKD to ESRD following new superimposed acute kidney injury (AKI) caused by new medical/surgical events. If SORO-ESRD is prevalent, this will call for major paradigm shifts in renoprotection strategies. We have extended our study to a CKD cohort from Nigeria and showed that ESRD occurred precipitously in at least three of 15 patients (20%) preceded by AKI. We concluded that SORO-ESRD was not uncommon in both CKD populations. In less-developed countries especially, where dialysis is expensive and scarce, preventive measures to reduce SORO-ESRD in otherwise stable CKD patients are warranted to reduce the overall ESRD burden.


Keywords


Acute kidney injury, chronic kidney disease, end-stage renal disease, estimated glomerular filtration rate, hemodialysis, renal replacement therapy, renoprevention, renoprotection, syndrome of rapid onset end-stage renal disease


Disclosure: The authors have no conflicts of interest to declare. Acknowledgments: The authors acknowledge the contribution of Dr Ejikeme Arodiwe, Consultant Nephrologist, of the University of Nigeria Teaching Hospital, Ituk-Ozalla, near Enugu, Nigeria for the data from his center. Received: November 5, 2010 Accepted: November 29, 2010 Citation: US Nephrology, 2010;5(2):81–5 Correspondence: Macaulay AC Onuigbo, MD, MSc, FWACP, FASN, Nephrologist/Hypertension Specialist/Transplant Physician, Department of Nephrology, Midelfort Clinic, Mayo Health System, 1221 Whipple Street, Eau Claire, WI 54702. E: onuigbo.macaulay@mayo.edu


By most estimates, we have continued to experience an increasing worldwide end-stage renal disease (ESRD) epidemic.1–5


Epidemiologic


data from Canada, the UK, Europe in general, Japan, Taiwan, Egypt, and worldwide continue to depict a growing ESRD population.1–5


Here in the


US, in 2007, using ESRD data then available for analysis, certain authorities concluded that the US ESRD population growth was beginning to flatten out.6


This latter view is supported by new ESRD data just released from the United States Renal Data System (USRDS).9


However, it must be acknowledged that other


reports at that time had attested to the contrary: that, in fact, the US ESRD epidemic had continued to grow, and had outpaced the diabetes epidemic.7,8


According to


statistics from the USRDS released in October 2010, the prevalent ESRD population in the US reached an all-time high of 547,982 in 2008.9


This


represents a 1.2% increase from 2007, according to the USRDS reports; an even greater rate of growth compared with the US ESRD population growth rate of 0.85% between 2006 and 2007.9


These increases in ESRD


populations worldwide are occurring in spite of at least two decades of intensified so-called renoprotection strategies, including attempts at optimal hypertension management, optimization of diabetic control,


© TOUCH BRIEFINGS 2010


The scourge of an ensuing worldwide ESRD pandemic remains a major public health quagmire, more so in developing countries, either with a paucity of renal replacement therapy (RRT) facilities, or where RRT services are available but are so expensive that generally most patients cannot afford to self-pay for them.18–27


The experiences from Nigeria,


South-East Asia and the Indian subcontinent, Eastern Europe, and South America reveal an abysmal paucity of RRT options; even where available in developing countries RRT is almost always unaffordable for large segments of the population.18–27


1995, only one-third of patients needing RRT received the treatment.19


For example, in Romania, as recently as In


some other, even less-developed countries, the picture is far worse: quite often in some areas RRT facilities are non-existent, and ESRD patients are forced by these unfortunate and dire circumstances to seek ineffective alternative therapies, to go to prayer houses for help, or simply to go home and die.21,27


81


smoking cessation efforts, and the extensive application of renin- angiotensin-aldosterone system (RAAS) blockade in both diabetic and non-diabetic chronic nephropathies.10–17


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