Prediction and prevention of chronic renal impairment in high-risk populations. Type 2 diabetes, hypertension & lung transplantation

PhD ceremony: Ms. M.E. Hellemons, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Prediction and prevention of chronic renal impairment in high-risk populations. Type 2 diabetes, hypertension & lung transplantation

Promotor(s): prof. D. de Zeeuw, prof. G.J. Navis

Faculty: Medical Sciences

The prediction and prevention of chronic renal impairment is of utmost importance, as it is associated with increased risk for end-stage renal disease, cardiovascular complications and death. Patients with various characteristics have increased risk of developing chronic renal impairment, although not all of them will eventually develop it. To date, differentiation between patients that will and will not develop chronic renal impairment is not feasible.

Patients with type 2 diabetes or hypertension have an increased risk for chronic renal impairment. The numbers of patients in these high-risk groups are rapidly increasing, the risk of chronic renal impairment is modestly increased, and patients are initially mostly treated in primary care. This contrasts with the group of pulmonary transplant recipients, which is a relatively small group of patients with a largely increased risk for chronic renal impairment that is exclusively treated in highly specialized centers.

In these very different groups of high-risk patients we looked at 1) early detection of and discrimination between patient with and without increased risk of fast-progressive chronic renal impairment and 2) the most effective treatment strategies. This thesis provides an overview of the currently known biomarkers for the prediction of chronic renal impairment. Several novel biomarkers are described that are associated with chronic renal impairment and improved discrimination between patients. As early detection and treatment may prevent or at least delay long term-complications, we also looked at early detection in clinical practice, adequacy of treatment and changes over time.