Predictors of a Rapid Decline of Renal Function in Patients with Chronic Kidney Disease Referred to a Nephrology Outpatient Clinic: A Longitudinal Study

Vigil, Ana; Condés, Emilia; Camacho, Rosa; Cobo, Gabriela; Gallar, Paloma; Oliet, Aniana; Rodríguez, Isabel; Ortega, Olimpia; Mon, Carmen; Ortiz, Milagros; Herrero, Juan Carlos

doi:10.1155/2015/657624

Cited by 14 publications

(16 citation statements)

References 33 publications

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“…A subset of patients with at least 10-year follow-up were further evaluated with the aim of assessing the longitudinal changes in graft function, using eGFR values at discharge after transplant (baseline) and at the annual follow-up visits, in the whole group and in KTRs stratified according to age ranges. A longitudinal multivariable linear regression model was applied to determine the relationship between the yearly change in eGFR after transplantation and the performance related to PA [ 32 , 33 ]. The analysis was conducted by fitting a mixed-effect (random-and-fixed) linear-regression model (for repeated measures), considering that the model assumes that the determinations from a single subject share a set of latent, unobserved, random effects which are used to generate an association structure between the repeated measurements [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

Physical activity and renal function in the Italian kidney transplant population

Masiero¹,

Puoti²,

Bellis³

et al. 2020

Renal Failure

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Background: The well-documented benefits of physical activity (PA) are still poorly characterized in long-term kidney transplant outcome. This study analyzed the impact over a 10-year follow-up of PA on graft function in Italian kidney transplant recipients (KTRs). Methods: Since 2002, the Italian Transplant-Information-System collected donor and recipient baseline and transplant-related parameters in KTRs. In 2015, 'penchant for PA' (PA ! 30-min, 5 times/week) was added. Stable patients aged !18 years at the time of first-transplantation were eligible. KTRs with at least 10-year follow-up were also analyzed. Mixed-effect regression models were used to compare eGFR changes over time in active versus non-active patients. Results: PA information was available for 6,055 KTRs (active 51.6%, non-active 48.4%). Lower penchant for PA was found in overweight and obese patients (OR ¼ 0.84; OR ¼ 0.48, respectively), in those with longer dialysis vintage (OR ¼ 0.98 every year of dialysis), and older age at transplant. Male subjects showed greater penchant for PA (OR ¼ 1.25). A slower decline of eGFR over time was observed in active KTRs compared to non-active, and this finding was confirmed in the subgroup with at least 10-year follow-up (n ¼ 2,060). After applying the propensity score matching to reduce confounding factors, mixed-effect regression models corroborated such better long-term trend of graft function preservation in active KTRs. Conclusions: Penchant for PA is more frequent among male and younger KTRs. Moreover, in our group of Italian KTRs, active patients revealed higher eGFR values and preserved kidney function over time, up to 10-years of follow-up.

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Section: Methodsmentioning

confidence: 99%

Physical activity and renal function in the Italian kidney transplant population

Masiero¹,

Puoti²,

Bellis³

et al. 2020

Renal Failure

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“…One particular omission from current prediction tools involves quantifying the rate of change in renal function in patients over time, which can help conceptualise an individual's risk profile more meaningfully [6,7]. Although a number of studies have explored the association of various risk factors on different rates of progression [8][9][10], there is a lack of data focusing exclusively on patients with a consistent linear rate of progression and the associations with adverse outcomes such as ESRD and mortality. These patients warrant attention as their linear eGFR trajectory represents a clear paradigm for understanding true CKD progression.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

et al. 2020

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Background: Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear estimated glomerular filtration rate (eGFR) trajectory represent a clear paradigm for understanding true CKD progression. Methods: A linear regression slope was applied to all outpatient eGFR values for patients in the Salford Kidney Study who had ≥2 years follow-up, ≥4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤ − 4 ml/min/1.73m 2 /yr defined rapid progressors, whereas − 0.5 to + 0.5 ml/min/1.73m 2 /yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD. Results: There were 157 rapid progressors (median ΔeGFR − 5.93 ml/min/1.73m 2 /yr) and 179 stable patients (median ΔeGFR − 0.03 ml/min/1.73m 2 /yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of > 50 g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure. Conclusions: There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

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“…One particular omission from current prediction tools involves quantifying the rate of change in renal function in patients over time, which can help conceptualise an individual's risk pro le more meaningfully [6,7]. Although a number of studies have explored the association of various risk factors on different rates of progression [8][9][10], there is a lack of data focusing exclusively on patients with a consistent linear rate of progression and the associations with adverse outcomes such as ESRD and mortality. These patients warrant attention as their linear eGFR trajectory represents a clear paradigm for understanding true CKD progression.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Ali

Chinnadurai

Ibrahim

et al. 2020

Preprint

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Abstract Background Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear eGFR trajectory represent a clear paradigm for understanding true CKD progression. Methods A linear regression slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for patients in the Salford Kidney Study who had ≥2years follow-up, ≥4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤-4ml/min/1.73m2/yr defined rapid progressors, whereas -0.5 to +0.5ml/min/1.73m2/yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD. Results There were 157 rapid progressors (median ΔeGFR -5.93ml/min/1.73m2/yr) and 179 stable patients (median ΔeGFR -0.03ml/min/1.73m2/yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of >50g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure. Conclusions There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

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Predictors of a Rapid Decline of Renal Function in Patients with Chronic Kidney Disease Referred to a Nephrology Outpatient Clinic: A Longitudinal Study

Cited by 14 publications

References 33 publications

Physical activity and renal function in the Italian kidney transplant population

Physical activity and renal function in the Italian kidney transplant population

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

Predictive factors of rapid linear renal progression and mortality in patients with chronic kidney disease

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