Past Decline Versus Current eGFR and Subsequent Mortality Risk

Abstract

A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope ,25 ml/min per 1.73 m 2 per year, whereas 7% and 4% had a slope .5 ml/min per 1.73 m 2 per year, respectively. Compared with a slope of 0 ml/min per 1.73 m 2 per year, a slope of 26 ml/min per 1.73 m 2 per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m 2 per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus ,3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.

Estimated glomerular filtration rate and risk of poor outcomes after stroke

“…Our findings show higher risk of poor outcomes for moderately to severely reduced eGFR but lower risk for mildly and mild to moderately decreased eGFR. Similar findings have been observed previously in general population cohorts [15,16]. These findings are probably due to the severity of illness of patients in the eGFR category of ≥90 ml/min/1.73 m 2 .…”

“…Causes of increased risk for poor prognosis with increase in eGFR during hospital stay are unclear. It is possible that an increase in eGFR during hospital stay may not indicate true improvement in kidney function but may indicate deterioration of physical condition which may have resulted in overestimation of kidney function at the second measurement closer to discharge .…”

Risk of ESRD and Mortality Associated With Change in Filtration Markers

“…Some studies have reported significant associations between a rise in eGFR and mortality risk. 10–14 In the CKD Prognosis Consortium, a eGFR cr slope of +6 mL/min/1.73 m 2 per year was associated with 1.58 (95% CI, 1.29–1.95) times higher risk of all-cause mortality in a meta-analysis of CKD cohorts. 14 We would expect an increase in mGFR to be associated with better health outcomes.…”

“…10–14 In the CKD Prognosis Consortium, a eGFR cr slope of +6 mL/min/1.73 m 2 per year was associated with 1.58 (95% CI, 1.29–1.95) times higher risk of all-cause mortality in a meta-analysis of CKD cohorts. 14 We would expect an increase in mGFR to be associated with better health outcomes. Alternatively, a rise in mGFR might reflect glomerular hyperfiltration or recovery from an acute kidney injury episode, which may be associated with adverse health outcomes.…”

“…8,9 Prior studies have reported a U-shaped relationship with both decline and rise in eGFR cr demonstrating adverse health consequences, although there are some inconsistencies for eGFR cr rise. 10–14 Risk of ESRD and mortality associated with change in novel filtration markers (cystatin C, β-trace protein [BTP], and β 2 -microglobulin [B2M]) has not been previously assessed in a CKD study population.…”