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.
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