Estimated Glomerular Filtration Rate Variability Independently Predicts Renal Prognosis in Advanced Chronic Kidney Disease Patients

Uehara, K.; Yasuda, Takashi; Shibagaki, Yugo; Kimura, Kenjiro

doi:10.1159/000438460

Cited by 14 publications

(9 citation statements)

References 28 publications

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“…DOI: 10.1159/000487714 ity tended to be older (median 68 years vs. 62.5 years in low eGFR variability group, p < 0.001) and male (94 vs. 76% in low eGFR variability group). However, similar to our findings, patients with high eGFR variability were 2.1 times more likely to experience progression to ESRD, requiring transplant or dialysis [19]. Authors indicate that visit-to-visit variability in eGFR should be evaluated on a larger scale and that eGFR slope and eGFR variability may be useful in predicting outcomes [19].…”

Section: Discussionsupporting

confidence: 86%

“…Uehara et al [19] also performed a post hoc analysis of a pharmacologic intervention trial to determine if patients with advanced kidney disease who had higher eGFR variability would hasten their progression to ESRD requiring transplant or dialysis. A total of 237 patients were included in their final analysis and contrary to our findings, patients with high eGFR variabil- Fig.…”

Section: Discussionmentioning

confidence: 99%

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Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

et al. 2018

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Background: Several studies have been performed to evaluate surrogate markers of long-term allograft function in renal transplant recipients. These include serum creatinine, estimated glomerular filtration rate (eGFR), slope of eGFR, and more recently eGFR variability. The aim of this study was to measure eGFR slope while assessing the variability of this slope and if high variability occurring at any time post-transplant was predictive of poorer long-term outcomes in a large cohort of kidney transplant recipients. Methods: Adult solitary kidney transplant recipients transplanted between July 1, 2005 and July 31, 2015 were included. The primary outcome was time to graft loss, defined as return to chronic dialysis, retransplant, or death. Secondary outcomes were death-censored graft loss and acute allograft rejection. Cox regression was utilized for primary and secondary outcomes. Multivariate logistic regression was used to determine baseline factors predictive of high eGFR variability. Results: A total of 1,543 patients were included in the analysis. The percentage of patients who experienced an eGFR coefficient of variation of <30% was 79.6% (1,229/1,543), while 20.4% (314/1,543) patients had high eGFR variability (≥30%). Patients with high eGFR variability tended to be younger, African-American and female. Those with higher eGFR variability, accounting for confounding and other eGFR measures (peak and slope), had significantly lower overall patient and graft survival. Conclusion: This study provides a novel analysis of the utility of eGFR variability in a large cohort. The clinical use of the slope of eGFR and eGFR variability may aid in predicting long-term graft outcomes and facilitate early patient discussions to change the trajectory of allograft function.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

et al. 2018

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“…A previous study showed that renal function has little influence on the urine PCR 19 . Moreover, proteinuria declines with glomerulosclerosis and advanced stages of CKD exhibit disturbed circadian blood pressure rhythms 20 , structurally deficient arterioles 21 and eGFR variability 22 . Whether the exception described above is due to the reasons discussed here remains unknown.…”

Section: Discussionmentioning

confidence: 99%

The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China

Huan¹,

Luo²,

Wang³

et al. 2016

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OBJECTIVE:This study investigated the correlation between the albumin-to-creatinine ratio in the urine and 24-hour urine proteinuria and whether the ratio can predict chronic kidney disease progression even more reliably than 24-hour proteinuria can, particularly in primary IgA nephropathy.METHODS:A total of 182 patients with primary IgA nephropathy were evaluated. Their mean urine albumin-to-creatinine ratio and 24-hour proteinuria were determined during hospitalization. Blood samples were also analyzed. Follow-up data were recorded for 44 patients. A cross-sectional study was then conducted to test the correlation between these parameters and their associations with chronic kidney disease complications. Subsequently, a canonical correlation analysis was employed to assess the correlation between baseline proteinuria and parameters of the Oxford classification. Finally, a prospective observational study was performed to evaluate the association between proteinuria and clinical outcomes. Our study is registered in the Chinese Clinical Trial Registry, and the registration number is ChiCTR-OCH-14005137.RESULTS:A strong correlation (r=0.81, p<0.001) was found between the ratio and 24-hour proteinuria except in chronic kidney disease stage 5. First-morning urine albumin-to-creatinine ratios of ≥125.15, 154.44 and 760.31 mg/g reliably predicted equivalent 24-hour proteinuria ‘thresholds’ of ≥0.15, 0.3 and 1.0 g/24 h, respectively. In continuous analyses, the albumin-to-creatinine ratio was significantly associated with anemia, acidosis, hypoalbuminemia, hyperphosphatemia, hyperkalemia, hypercholesterolemia and higher serum cystatin C. However, higher 24-hour proteinuria was only associated with hypoalbuminemia and hypercholesterolemia. Higher tubular atrophy and interstitial fibrosis scores were also associated with a greater albumin-to-creatinine ratio, as observed in the canonical correlation analysis. Finally, the albumin-to-creatinine ratio and 24-hour proteinuria were associated with renal outcomes in univariate analyses.CONCLUSION:This study supports the recommendation of using the albumin-to-creatinine ratio, rather than 24-hour proteinuria, to monitor proteinuria and prognosis in primary IgA nephropathy.

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“…For example, CRIC participants initiating hemodialysis with an antecedent abrupt decline in kidney function (8.5%) experienced, on average, a 3-fold higher risk for death within the first year of dialysis [23]. There is emerging literature suggesting that, independent of long-term GFR trajectory over time, short-term variations in eGFR are predictive of kidney disease outcomes [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

American Indian chronic Renal insufficiency cohort study (AI-CRIC study)

et al. 2020

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Background: Chronic kidney disease (CKD) is an increasing epidemic globally that is associated with adverse health outcomes including end stage kidney disease (ESKD), cardiovascular disease (CVD), and death. American Indians (AIs) have a higher prevalence of CKD than most other racial/ethnic groups, due in part to a high prevalence of type 2 diabetes. Other genetic and environmental factors not yet identified may also contribute to the disproportionate burden of CKD in AIs. Method: We will establish 3 clinical centers to recruit AIs from the Southwest United States (US) to expand the Chronic Renal Insufficiency Cohort (CRIC) study. We will follow the current CRIC protocol for kidney and cardiovascular measures and outcomes, which include ambulatory monitoring of kidney function and the use of mobile health technologies for CVD sub-phenotyping, and compare the outcomes in AIs with those in other racial/ ethnic groups in CRIC. Discussion: AI-CRIC will identify the role of various risk factors for rapid loss of kidney function among AIs of the Southwest US. In addition, to better understand the natural history of CKD and CVD in this high-risk population, we will identify unique risk factors for CKD and CVD progression in AIs. We will also compare event rates and risk factors for kidney and cardiovascular events in AIs with the other populations represented in CRIC.

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Estimated Glomerular Filtration Rate Variability Independently Predicts Renal Prognosis in Advanced Chronic Kidney Disease Patients

Cited by 14 publications

References 28 publications

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

Renal Function Variability: An Independent Risk Factor for Graft Loss and Death following Kidney Transplantation

The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China

American Indian chronic Renal insufficiency cohort study (AI-CRIC study)

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