Rate of Kidney Function Decline Associates with Mortality

Al‐Aly, Ziyad; Zeringue, Angelique; Fu, John; Rauchman, Michael; McDonald, Jay R.; El‐Achkar, Tarek M.; Balasubramanian, Sumitra; Nurutdinova, Diana; Xian, Hong; Stroupe, Kevin T.; Abbott, Kevin C.; Eisen, Seth A.

doi:10.1681/asn.2009121210

Cited by 179 publications

(201 citation statements)

References 42 publications

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“…Indeed, according to this study, GPs can be considered as a reference of care for patients in stage 3a without asking for nephrology consultation, because these patients have the same risk as the reference group (Table 4). The clinical characteristics of our patients with CKD stage 3a, in fact, show low prevalence for the main cardiorenal risk factors (i.e., albuminuria, anemia, diabetes, and CAD) with respect to more advanced stages of CKD (3b-5), and therefore, their profile is compatible with nonprogressive CKD (26)(27)(28)(29)(30). However, the suggestion of referring patients with CKD when eGFR is ,45 ml/min per 1.73m 2 is in agreement with the timing of onset of CKD-related metabolic complications (31).…”

Section: Discussionmentioning

confidence: 76%

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Minutolo

Lapi

Chiodini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Rising prevalence of CKD requires active involvement of general practitioners to limit ESRD and mortality risk. However, the outcomes of patients with CKD exclusively managed by general practitioners are ill defined. Results Overall 64% of patients were in stage 3a, and 4.5% of patients were in stages 3b-5. Patients with stages 1 and 2 were younger, were predominantly men, more frequently had diabetes, and had lower prevalence of previous cardiovascular disease than patients with stages 3a-5. Hypertension was frequent in all CKD stages (80%-94%), whereas there was a lower prevalence of dyslipidemia, albuminuria, and obesity associated with more advanced CKD. During the follow-up (median=7.2 years; interquartile range=4.7-7.7), 6592 patients died and 295 started ESRD. Compared with stages 1 and 2 (reference), mortality risk (hazard ratio, 95% confidence interval) was higher in stages 3b-5 (1.66, 1.49-1.86, 2.75, 2.41-3.13 and 2.54, 2.01-3.22, respectively) but not stage 3a (1.11, 0.99-1.23). Similarly, ESRD risk (hazard ratio, 95% confidence interval) was not higher at stage 3a (1.44, 0.79-2.64) but was greater in stages 3b-5 (11.0, 6.3-19.5, 91.2, 53.2-156.2 and, 122.8, 67.9-222.0, respectively). Among modifiable risk factors, anemia and albuminuria significantly predicted either outcome, whereas hypertension only predicted mortality.Conclusions In patients with CKD not referred to nephrology, risks of ESRD and mortality were higher in those with CKD stages 3b-5.

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Section: Discussionmentioning

confidence: 76%

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Minutolo

Lapi

Chiodini

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Other community-based approaches have been successful, such as the integrated model of care using community health workers for Maori and Pacific Islander participants with CKD and hypertension that resulted in improved BP control and albuminuria; these are key to developing targeted management approaches (30). In addition, incorporation of the rate of eGFR decline into the CKD definition may help identify high-risk patients (31). Longer-term follow-up of this cohort will further inform these clinical implications.…”

Section: Discussionmentioning

confidence: 99%

Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study

Maple-Brown¹,

Hughes²,

Ritte³

et al. 2016

CJASN

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Background and objectives Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR.Design, setting, participants, & measurements This observational longitudinal study of Indigenous Australian adults was conducted in .20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2-4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of $30% eGFR decline with follow-up eGFR,60 ml/min per 1.73 m 2 , progression to RRT, or renal death).Results Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m 2 , respectively. Overall mean annual eGFR change was 23.1 (23.6 to 22.5) ml/min per 1.73 m 2 . Stratified by baseline eGFR ($90, 60-89, ,60 ml/min per 1.73 m 2 ), annual eGFR changes were 23.0 (23.6 to 22.4), 21.9 (23.3 to 20.5), and 25.0 (26.5 to 23.6) ml/min per 1.73 m 2 . Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) .265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein.Conclusions The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.

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“…Similar to previous work, in which adjustments were made for either the first or last eGFR in the antecedent period, we found a U-shaped relationship between eGFR slope and subsequent ACM risk. 11,[13][14][15][16] Direct, quantitative comparison between the results of these investigations and our own investigations are hampered by different indices of renal function change, different antecedent periods, and the use of rates, in some studies, rather than HRs to quantify mortality risk. However, Turin et al 12 found adjusted HRs for ACM of 1.14 and 1.68 for 4-ml/min per 1.73 m 2 per year declining and increasing slopes, respectively, compared with subjects with a stable eGFR value in a Canadian population-based study.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 A surprising finding in previous studies was that an increase in eGFR was associated with an increased risk of mortality. Whether these observations are generalizable is uncertain, because they were on the basis of data from single centers 13,14 and/or cohorts with mean baseline eGFR values of $50 ml/min per 1.73 m 2 . [11][12][13][14][15][16] Improvement in eGFR in a CKD population might show different associations with mortality than that in a general population cohort.…”

mentioning

confidence: 99%

Past Decline Versus Current eGFR and Subsequent Mortality Risk

Naimark

Grams

Matsushita

et al. 2015

JASN

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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.

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Rate of Kidney Function Decline Associates with Mortality

Cited by 179 publications

References 42 publications

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Risk of ESRD and Death in Patients with CKD Not Referred to a Nephrologist

Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study

Past Decline Versus Current eGFR and Subsequent Mortality Risk

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