Risk of ESRD and Mortality Associated With Change in Filtration Markers

Chronic Kidney Disease Biomarkers Consortium

Research output: Contribution to journalArticlepeer-review

Abstract

Background Using change in estimated glomerular filtration rate (eGFR) based on creatinine concentration as a surrogate outcome in clinical trials of chronic kidney disease has been proposed. Risk for end-stage renal disease (ESRD) and all-cause mortality associated with change in concentrations of other filtration markers has not been studied in chronic kidney disease populations. Study Design Observational analysis of 2 clinical trials. Setting & Participants Participants in the MDRD (Modification of Diet in Renal Disease; n = 317) Study and AASK (African American Study of Kidney Disease and Hypertension; n = 373). Predictors Creatinine, cystatin C, β-trace protein (BTP), and β2-microglobulin (B2M) were measured in serum samples collected at the 12- and 24-month follow-up visits, along with measured GFR (mGFR) at these time points. Outcomes ESRD and all-cause mortality. Measurements Poisson regression was used to estimate incidence rate ratios and 95% CIs for ESRD and all-cause mortality during long-term follow-up (10-16 years) per 30% decline in mGFR or eGFR for each filtration marker and the average of all 4 markers. Results 1-year decline in mGFR, eGFRcr, eGFRBTP, and the average of the 4 filtration markers was significantly associated with increased risk for incident ESRD in both studies (all P ≤ 0.02). Compared to mGFR, only decline in eGFRBTP was statistically significantly more strongly associated with ESRD risk in both studies (both P ≤ 0.03). Decline in eGFRcr, but not mGFR or the other filtration markers, was significantly associated with risk for all-cause mortality in AASK only (incidence rate ratio per 30% decline, 4.17; 95% CI, 1.78-9.74; P < 0.001), but this association was not significantly different from decline in mGFR (P = 0.2). Limitations Small sample size. Conclusions Declines in mGFR, eGFRcr, eGFRBTP, and the average of 4 filtration markers (creatinine, cystatin C, BTP, and B2M) were consistently associated with progression to ESRD.

Original languageEnglish (US)
Pages (from-to)551-560
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume70
Issue number4
DOIs
StatePublished - Oct 2017

Keywords

  • Beta-2-microglobulin (B2M)
  • beta trace protein (BTP)
  • creatinine
  • cystatin C
  • death
  • end-stage renal disease (ESRD)
  • estimated GFR
  • filtration markers
  • glomerular filtration rate (GFR)
  • incident ESRD
  • kidney function decline
  • measured GFR
  • mortality

ASJC Scopus subject areas

  • Nephrology

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