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Slower decline in eGFR associated with lower risk of ESKD
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Slower decline in eGFR may be associated with a subsequent lower risk of ESKD, according to a recent random effects meta-analysis of 3,943,212 patients.
“These results add to the analyses of clinical trials — where a treatment effect of 0.75 mL/min per 1.73 m2 per year in the total slope was associated with a 27% lower hazard for the treatment effect on the clinical end point — by quantifying the associations between slope measured over the relatively short term and the subsequent long-term risk of clinical events and by demonstrating consistency, even in populations with eGFR [equal to or greater than] 60 mL/min per 1.73 m2,” Morgan E. Grams, MD, of Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland’s department of epidemiology, and colleagues wrote. “ ... however, they also suggest that eGFR slope as a surrogate end point may not be useful in slowly progressing populations or short-term studies, particularly when a treatment has an acute effect on eGFR.”
Participant data from the [Chronic Kidney Disease] CKD Prognosis Consortium were examined and stratified by baseline eGFR, with two separate analyses performed for participants with eGFR less than 60 mL/min per 1.73 m2 and greater than or equal to 60 mL/min per 1.73 m2. A total of 14 cohorts were evaluated during a period of 3 years, with 3,353,210 individuals included in year 1; 3,881,215 in year 2; and 3,943,212 in year 3. Only adult participants without EKSD present during or before the baseline time period were considered, with the EKSD outcome defined as initiation of kidney replacement therapy.
Slowed eGFR decline was associated with lowered ESKD risk in the group with eGFR less than 60 mL/min per 1.73 m2 (aHR = 0.71) and the group with eGFR greater than or equal to 60 mL/min per 1.73 m2 (aHR = 0.7) for 2 years, with relationship strength between eGFR and ESKD risk increased further in the 3 years analysis. A less significant eGFR decline of 0.75 mL/min per 1.73 m2 per year was also associated with lower ESKD risk across all cohorts. A total of 6,083 ESKD events and 44,135 deaths were observed in the group with eGFR less than 60 mL/min per 1.73 m2 for an average follow-up of 3.3 years, with 6,552 events and 520,061 deaths recorded during a mean of 4.2 years within the cohort of individuals with eGFR of 60 mL/min per 1.73 m2 or greater.
“However, eGFR slopes do not address safety, and they are unlikely to be useful in the short term for a treatment with an acute effect or a population with low risk of CKD progression,” the researchers wrote. “In conjunction with recent work in clinical trials and statistical simulation, these results may support the validity of eGFR slope as a surrogate end point in select clinical trials.”– by Eamon Dreisbach
Disclosures: Grams reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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