Past decline versus current EGFR and subsequent ESRD risk

Csaba P. Kovesdy, Josef Coresh, Shoshana H. Ballew, Mark Woodward, Adeera Levin, David M.J. Naimark, Joseph Nally, Dietrich Rothenbacher, Benedicte Stengel, Kunitoshi Iseki, Kunihiro Matsushita, Andrew S. Levey

Research output: Contribution to journalArticle

Abstract

EGFRis a robustpredictor ofESRDrisk.However, the prognostic informationgainedfromthepast trajectory (slope) beyondthat of the currentEGFRisunclear.Weexamined22cohorts todeterminethe associationofpast slopes and current EGFR level with subsequent ESRD. We modeled hazard ratios as a spline function of slopes, adjusting for demographic variables,EGFR,andcomorbidities.Weusedrandomeffectsmeta-analyses tocombineresults across studies stratified by cohort type.We calculated the absolute risk of ESRD at 5 years after the last EGFR using the weighted average baseline risk. Overall, 1,080,223 participants experienced 5163 ESRD events during a mean follow-up of 2.0 years. InCKDcohorts, a slope of26versus0ml/minper 1.73m2 per year over the previous 3 years (adeclineof 18ml/minper1.73m2 versus no decline) associated with an adjusted hazard ratio of ESRDof 2.28 (95% confidence interval, 1.88 to 2.76). In contrast, a current EGFR of 30 versus 50 ml/min per 1.73m2 (a difference of 20 ml/min per 1.73 m2) associated with an adjusted hazard ratio of 19.9 (95% confidence interval, 13.6 to 29.1). Past decline contributed more to the absolute risk of ESRD at lower than higher levels of current EGFR. In conclusion, during a follow-up of 2 years, current EGFR associates more strongly with future ESRD risk than the magnitude of past EGFR decline, but both contribute substantially to the risk of ESRD, especially at EGFR,30ml/min per 1.73m2.

Original languageEnglish (US)
Pages (from-to)2447-2455
Number of pages9
JournalJournal of the American Society of Nephrology
Volume27
Issue number8
DOIs
StatePublished - 2016

ASJC Scopus subject areas

  • Nephrology

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    Kovesdy, C. P., Coresh, J., Ballew, S. H., Woodward, M., Levin, A., Naimark, D. M. J., Nally, J., Rothenbacher, D., Stengel, B., Iseki, K., Matsushita, K., & Levey, A. S. (2016). Past decline versus current EGFR and subsequent ESRD risk. Journal of the American Society of Nephrology, 27(8), 2447-2455. https://doi.org/10.1681/ASN.2015060687