Open Journal of Nephrology, 2013, 3, 139-147 http://dx.doi.org/10.4236/ojneph.2013.33026 Published Online September 2013 (http://www.scirp.org/journal/ojneph) Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease Carlos Enrique Yepes Delgado * , Yanett Marcela Montoya Jaramillo, Beatriz Elena Orrego Orozco, Paulina Bernal Ramírez, Luz Denise González, José Miguel Abad Echeverri, María Patricia Arbeláez Montoya University of Antioquia, Hospital Pablo Tobón Uribe, EPS SURA, Medellín, Colombia Email: * caenyede@gmail.com Received July 13, 2013; revised August 5, 2013; accepted August 14, 2013 Copyright © 2013 Carlos Enrique Yepes Delgado et al. This is an open access article distributed under the Creative Commons Attri- bution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: There are many programs which focus on late-stage chronic kidney disease (CKD), and it is considered that further evidence needs to be generated regarding the effectiveness of the programs used before renal replacement therapy. Study Design: A cohort study. Settings & Participants: Patients over 15 years of age who had been diagnosed with CKD according to the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines and who had undergone conventional treatment (CT) or a renal protection program (RPP). These were patients of two Colombian health insur- ance companies. Predictors: Age, sex, marital status, comorbidities, CKD stage, and clinical indicators. Outcomes: First CKD progression, and need for renal replacement therapy (RRT). Measures: Clinical marker. Results: The RPP is structurally and functionally different from the CT. It offers the interdisciplinary management of patients, a greater number of medical appointments, and patients start to receive treatment at younger ages and at earlier stages of their condition. The clinical markers of the patients following the RPP are within adequate ranges, and their renal function is less impaired, despite the differences in basal conditions. Upon finishing the study, we found that patients who received CT had a higher risk of receiving nephrotoxic drugs and not receiving nephroprotective drugs. The explanatory vari- ables for the first progression were age, stage, history of dyslipidemia, and hemoglobin, potassium, and albumin levels. These variables, together with glycemia levels were also valid for RRT, except for history of dyslipidemia, as it was not significant. Upon adjusting for the explanatory variables, it was found that belonging to the RPP and attending more appointments had a protective effect in the process of controlling renal damage. Limitations: A possible selection bias. Conclusions: Belonging to a structured renal protection program is an effective way to keeping the clinical markers as- sociated with renal impairment within normal ranges. Keywords: Chronic Kidney Disease; Renal Protection Program; Effectiveness; Clinical Markers; Progression of Renal Damage; Renal Replacement Program 1. Introduction Due to the rapid increase in its prevalence, its close relationship with an increased risk of cardiovascular disease, and the high costs of treatment, chronic kidney disease (CKD) is now recognized as a public health problem that affects people of all ages and alters their quality of life [1,2]. Because of these characteristics, this disease is becoming a priority for healthcare systems. This has created an urgent need to develop effective ways of measuring interventions to prevent its progress [3,4]. According to the calculations of the National Health and Nutrition Examination Survey (NHANES) III, it is estimated that twenty million adults have CKD in the United States. Currently, approximately 360,000 patients have undergone renal replacement therapy (RRT) in the European Union. In developed countries, it is estimated that the number of people with end-stage CKD will continue to increase at an annual rate of around 5% to 8%. This growth is driven by population aging and the increased incidence of diseases related to renal failure [5]. In Colombia, there are over 20,000 individuals with stage 5 CKD, with an age-adjusted prevalence of 454 * Corresponding author. Copyright © 2013 SciRes. OJNeph