TY - JOUR
T1 - Change in measured GFR versus eGFR and CKD outcomes
AU - CRIC Study Investigators
AU - Ku, Elaine
AU - Xie, Dawei
AU - Shlipak, Michael
AU - Anderson, Amanda Hyre
AU - Chen, Jing
AU - Go, Alan S.
AU - He, Jiang
AU - Horwitz, Edward J.
AU - Rahman, Mahboob
AU - Ricardo, Ana C.
AU - Sondheimer, James H.
AU - Townsend, Raymond R.
AU - Hsu, Chi yuan
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Kusek, John W.
AU - Lash, James P.
AU - Ojo, Akinlolu
N1 - Publisher Copyright:
Copyright © 2016 by the American Society of Nephrology.
PY - 2016
Y1 - 2016
N2 - Measured GFR (mGFR) has long been considered the gold standard measure of kidney function, but recent studies have shown that mGFR is not consistently superior to eGFR in explaining CKD-related comorbidities. The associations between longitudinal changes in mGFR versus eGFR and adverse outcomes have not been examined. We analyzed a subset of 942 participants with CKD in the Chronic Renal Insufficiency Cohort Study who had at least two mGFRs and two eGFRs determined concurrently by iothalamate and creatinine (eGFRcr) or cystatin C, respectively. We compared the associations between longitudinal changes in each measure of kidney function over 2 years and risks of ESRD, nonfatal cardiovascular events, and all-cause mortality using univariate Cox proportional hazards models. The associations for all outcomes except all-cause mortality associated most strongly with longitudinal decline in eGFRcr. Every 5-ml/min per 1.73 m2 decline in eGFRcr over 2 years associated with 1.54 (95% confidence interval, 1.44 to 1.66; P,0.001) times higher risk of ESRD and 1.23 (95% confidence interval, 1.12 to 1.34; P,0.001) times higher risk for cardiovascular events. All-cause mortality did not associate with longitudinal decline in mGFR or eGFR. When analyzed by tertiles of renal function decline, mGFR did not outperform eGFRcr in the association with any outcome. In conclusion, compared with declines in eGFR, declines in mGFR over a 2-year period, analyzed either as a continuous variable or in tertiles, did not consistently show enhanced association with risk of ESRD, cardiovascular events, or death.
AB - Measured GFR (mGFR) has long been considered the gold standard measure of kidney function, but recent studies have shown that mGFR is not consistently superior to eGFR in explaining CKD-related comorbidities. The associations between longitudinal changes in mGFR versus eGFR and adverse outcomes have not been examined. We analyzed a subset of 942 participants with CKD in the Chronic Renal Insufficiency Cohort Study who had at least two mGFRs and two eGFRs determined concurrently by iothalamate and creatinine (eGFRcr) or cystatin C, respectively. We compared the associations between longitudinal changes in each measure of kidney function over 2 years and risks of ESRD, nonfatal cardiovascular events, and all-cause mortality using univariate Cox proportional hazards models. The associations for all outcomes except all-cause mortality associated most strongly with longitudinal decline in eGFRcr. Every 5-ml/min per 1.73 m2 decline in eGFRcr over 2 years associated with 1.54 (95% confidence interval, 1.44 to 1.66; P,0.001) times higher risk of ESRD and 1.23 (95% confidence interval, 1.12 to 1.34; P,0.001) times higher risk for cardiovascular events. All-cause mortality did not associate with longitudinal decline in mGFR or eGFR. When analyzed by tertiles of renal function decline, mGFR did not outperform eGFRcr in the association with any outcome. In conclusion, compared with declines in eGFR, declines in mGFR over a 2-year period, analyzed either as a continuous variable or in tertiles, did not consistently show enhanced association with risk of ESRD, cardiovascular events, or death.
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U2 - 10.1681/ASN.2015040341
DO - 10.1681/ASN.2015040341
M3 - Article
C2 - 26604213
AN - SCOPUS:84999079279
SN - 1046-6673
VL - 27
SP - 2196
EP - 2204
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 7
ER -