TY - JOUR
T1 - Short-term change in kidney function and risk of end-stage renal disease
AU - Turin, Tanvir Chowdhury
AU - Coresh, Josef
AU - Tonelli, Marcello
AU - Stevens, Paul E.
AU - De Jong, Paul E.
AU - Farmer, Christopher K.T.
AU - Matsushita, Kunihiro
AU - Hemmelgarn, Brenda R.
N1 - Funding Information:
Acknowledgements. T.C.T. is supported by Fellowship Awards from the Canadian Institutes of Health Research (CIHR), Canadian Diabetes Association (CDA) and the Interdisciplinary Chronic Disease Collaboration (ICDC) team grant funded by Alberta Innovates—Health Solutions (AI-HS). B.R.H. and M.T. are supported by AI-HS Salary Awards. B.R. H. is supported by the Roy and Vi Baay Chair in Kidney Research and M.T. is supported by a Canada Research Chair. J.C. and K.M. are supported by grants to the CKD Prognosis Consortium from the National Kidney Foundation and its sponsors.
PY - 2012/10
Y1 - 2012/10
N2 - BackgroundIt is unclear what degree of change in the eGFR over a 1-year period indicates clinically significant progression, and whether this change adds additional information beyond that obtained by a single eGFR measure alone.MethodsWe included 598 397 adults who had at least two outpatient eGFR measurements (at least 6 months apart) during 1-year accrual period in Alberta, Canada. Change in kidney function (using the first and last eGFR) was defined by change in kidney function category with confirmation based on percent () change in eGFR [(last eGFR-first eGFR)/first eGFR × 100]. The groups for change in kidney function were thus defined as: 'certain drop' (drop in CKD category with <25 decrease in the eGFR); 'uncertain drop' (drop in CKD category with <25 decrease in the eGFR); 'stable' (no change in CKD category); 'uncertain rise' (rise in CKD category with <25 rise in the eGFR) and 'certain rise' (rise in CKD category with <25 increase in the eGFR). Adjusted end-stage renal disease (ESRD) rates (per 1000 person-years) for each group of change in kidney function were calculated using Poisson regression. Adjusted risks of ESRD associated with change in kidney function, in reference to stable kidney function, were estimated.ResultsAmong the 598 397 participants, 74.8 (n 447 570) had stable (no change in CKD category), 3.3 (n 19 591) had a certain drop and 3.7 (n 22 171) had a certain rise in kidney function. Participants who experienced a certain change in kidney function (both drop and rise) were older, more likely to be female, and had a higher prevalence of comorbidities, in comparison with those with stable kidney function. There were 1966 (0.3) ESRD events over a median follow-up of 3.5 years. Compared with participants with stable kidney function, after adjustment for covariates, and the first eGFR measurement, those with certain drop had 5-fold increased risk of ESRD (HR: 5.11; 95 CI: 4.56-5.71), whereas those with an uncertain drop had 2-fold increased risk (HR: 2.13; 95 CI: 1.84-2.47). After adjustment for the eGFR and covariates at the last visit, neither a certain nor uncertain drop in the eGFR was associated with an increased ESRD risk. The ESRD risk associated with the last eGFR level, adjusted for the slope over time, were 2.89 (95 CI: 2.35-3.55), 10.98 (95 CI: 8.69-13.87), 35.20 (95 CI: 27.95-44.32) and 147.96 (116.92-187.23) for categories 2, 3a, 3b and 4, respectively, in reference to category 1.ConclusionsA change in eGFR category accompanied by <25 decline (certain drop) is associated with increased ESRD risk. However, this elevated risk is captured by patient characteristics and eGFR at the last visit, suggesting that eGFR trajectories based on more than two serum creatinine measurements over a period longer than 1 year are required to determine ESRD risk and allow more reliable risk prediction.
AB - BackgroundIt is unclear what degree of change in the eGFR over a 1-year period indicates clinically significant progression, and whether this change adds additional information beyond that obtained by a single eGFR measure alone.MethodsWe included 598 397 adults who had at least two outpatient eGFR measurements (at least 6 months apart) during 1-year accrual period in Alberta, Canada. Change in kidney function (using the first and last eGFR) was defined by change in kidney function category with confirmation based on percent () change in eGFR [(last eGFR-first eGFR)/first eGFR × 100]. The groups for change in kidney function were thus defined as: 'certain drop' (drop in CKD category with <25 decrease in the eGFR); 'uncertain drop' (drop in CKD category with <25 decrease in the eGFR); 'stable' (no change in CKD category); 'uncertain rise' (rise in CKD category with <25 rise in the eGFR) and 'certain rise' (rise in CKD category with <25 increase in the eGFR). Adjusted end-stage renal disease (ESRD) rates (per 1000 person-years) for each group of change in kidney function were calculated using Poisson regression. Adjusted risks of ESRD associated with change in kidney function, in reference to stable kidney function, were estimated.ResultsAmong the 598 397 participants, 74.8 (n 447 570) had stable (no change in CKD category), 3.3 (n 19 591) had a certain drop and 3.7 (n 22 171) had a certain rise in kidney function. Participants who experienced a certain change in kidney function (both drop and rise) were older, more likely to be female, and had a higher prevalence of comorbidities, in comparison with those with stable kidney function. There were 1966 (0.3) ESRD events over a median follow-up of 3.5 years. Compared with participants with stable kidney function, after adjustment for covariates, and the first eGFR measurement, those with certain drop had 5-fold increased risk of ESRD (HR: 5.11; 95 CI: 4.56-5.71), whereas those with an uncertain drop had 2-fold increased risk (HR: 2.13; 95 CI: 1.84-2.47). After adjustment for the eGFR and covariates at the last visit, neither a certain nor uncertain drop in the eGFR was associated with an increased ESRD risk. The ESRD risk associated with the last eGFR level, adjusted for the slope over time, were 2.89 (95 CI: 2.35-3.55), 10.98 (95 CI: 8.69-13.87), 35.20 (95 CI: 27.95-44.32) and 147.96 (116.92-187.23) for categories 2, 3a, 3b and 4, respectively, in reference to category 1.ConclusionsA change in eGFR category accompanied by <25 decline (certain drop) is associated with increased ESRD risk. However, this elevated risk is captured by patient characteristics and eGFR at the last visit, suggesting that eGFR trajectories based on more than two serum creatinine measurements over a period longer than 1 year are required to determine ESRD risk and allow more reliable risk prediction.
KW - CKD stages
KW - change in eGFR
KW - chronic kidney disease
KW - end-stage renal disease
KW - population
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U2 - 10.1093/ndt/gfs263
DO - 10.1093/ndt/gfs263
M3 - Article
C2 - 22764191
AN - SCOPUS:84868556470
VL - 27
SP - 3835
EP - 3843
JO - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress
JF - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress
SN - 0931-0509
IS - 10
ER -