Change in Measured GFR Versus eGFR and CKD Outcomes

Ku, Elaine; Xie, Dawei; Shlipak, Michael G.; Anderson, Amanda H.; Chen, Jing; Go, Alan S.; He, Jiang; Horwitz, Edward; Rahman, Mahboob; Ricardo, Ana C.; Sondheimer, James; Townsend, Raymond R.; Hsu, Chi‐yuan

doi:10.1681/asn.2015040341

Cited by 42 publications

(42 citation statements)

References 51 publications

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“…Furthermore, the CKD-EPI is a better prognosticator of ESRD and mortality outcomes. 8,26 Similar to the findings of our study, the global estimate of CKD was lowered by 24% when CKD-EPI was used instead of the MDRD equation. 8 Although it would identify some patients as having CKD that MDRD would not, the net persons identified with CKD would be less using the CKD-EPI equation.…”

Section: Original Research and Contributionssupporting

confidence: 86%

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

Sim

Batech

Danforth

et al. 2017

TPJ

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Objectives: The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement.Methods: Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age-and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population.Results: Among 12,394 individuals, 83 (0.7%) reached ESRD. The age-and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p < 0.001). Screening with the Chronic Kidney Disease Epidemiology Collaboration (vs Modification Diet in Renal Diseases) equation would capture 44% fewer individuals and have a higher predictive value for CKD. Of those who had repeated creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD).Conclusion: Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.

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Section: Original Research and Contributionssupporting

confidence: 86%

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

Sim

Batech

Danforth

et al. 2017

TPJ

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“…Also, eGFR measurements were not uniformly spaced, a weakness that favors detection of too many rather than too few nonlinear trajectories as they become unstable in areas with sparse observations. Finally, we acknowledge that direct GFR measurements were not available in our patients; however, a recent study found that measured GFR compared with eGFR did not show an enhanced association with risk of ESRD, cardiovascular events, or death (39). …”

Section: Discussionmentioning

confidence: 96%

Patterns of Estimated Glomerular Filtration Rate Decline Leading to End-Stage Renal Disease in Type 1 Diabetes

et al. 2016

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OBJECTIVEThe patterns of estimated glomerular filtration rate (eGFR) decline to end-stage renal disease (ESRD) in patients with type 1 diabetes has not been conclusively described. Decline could be linearly progressive to ESRD but with a variable rate. Conversely, decline may be linear but interrupted by periods of plateaus or improvements.RESEARCH DESIGN AND METHODSThis observational study included 364 patients with type 1 diabetes attending the Joslin Clinic who developed ESRD between 1991 and 2013. We retrieved serum creatinine measurements from clinic visits or research examinations up to 24 years (median 6.7 years) preceding the onset of ESRD. Using serial measurements of serum creatinine to estimate renal function (eGFR), we used regression-based spline methods and a data smoothing approach to characterize individual trajectories of eGFR over time for the 257 patients with five or more data points.RESULTSThe rate of eGFR decline per year ranged widely, from −72 to −2 mL/min/1.73 m2 (median −8.5). The trajectories, as characterized with linear regression-based spline models, were linear or nearly so for 87% of patients, accelerating for 6%, and decelerating for 7%. Smoothed trajectories evaluated by a Bayesian approach did not significantly depart from a linear fit in 76%.CONCLUSIONSThe decline of eGFR in type 1 diabetes is predominantly linear. Deviations from linearity are small, with little effect on the expected time of ESRD. A single disease process most likely underlies renal decline from its initiation and continues with the same intensity to ESRD. Linearity of renal decline suggests using slope reduction as the measure of effectiveness of interventions to postpone ESRD.

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“…Finally, we decided to estimate rather than to measure GFR because measuring GFR in such a large sample size would be logistically challenging. In addition, measured GFR may have more variation than eGFR, introducing DOI: 10.1159/000490261 a larger error when using differences between 2 timepoints [49].…”

Section: Discussionmentioning

confidence: 99%

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease

Gritter

Vogt

Yeung

et al. 2018

Nephron

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Background/Aims: Dietary potassium (K⁺) has beneficial effects on blood pressure and cardiovascular (CV) outcomes. Recently, several epidemiological studies have revealed an association between urinary K⁺ excretion (as proxy for dietary intake) and better renal outcomes in subjects with chronic kidney disease (CKD). To address causality, we designed the “K⁺ in CKD” study. Methods: The K⁺ in CKD study is a multicenter, randomized, double blind, placebo-controlled clinical trial aiming to include 399 patients with hypertension, CKD stage 3b or 4 (estimated glomerular filtration rate [eGFR] 15–44 mL/min/1.73 m²), and an average eGFR decline > 2 mL/min/1.73 m²/year. As safety measure, all included subjects will start with a 2-week open-label phase of 40 mmol potassium chloride daily. Patients who do not subsequently develop hyperkalemia (defined as serum K⁺ >5.5 mmol/L) will be randomized to receive potassium chloride, potassium citrate (both K⁺ 40 mmol/day), or placebo for 2 years. The primary end point is the difference in eGFR after 2 years of treatment. Secondary end points include other renal outcomes (> 30% decrease in eGFR, doubling of serum creatinine, end-stage renal disease, albuminuria), ambulatory blood pressure, CV events, all-cause mortality, and incidence of hyperkalemia. Several measurements will be performed to analyze the effects of potassium supplementation, including body composition monitoring, pulse wave velocity, plasma renin and aldosterone concentrations, urinary ammonium, and intracellular K⁺ concentrations. Conclusion: The K⁺ in CKD study will demonstrate if K⁺ supplementation has a renoprotective effect in progressive CKD, and whether alkali therapy has additional beneficial effects.

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Change in Measured GFR Versus eGFR and CKD Outcomes

Cited by 42 publications

References 51 publications

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

Patterns of Estimated Glomerular Filtration Rate Decline Leading to End-Stage Renal Disease in Type 1 Diabetes

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease

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