eGFR variability linked to greater mortality risk but not cardiovascular events
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For patients with hypertension, variation in eGFR measurements over time appeared to increase risk for all-cause mortality but did not demonstrate an association with cardiovascular events.
“Some prior studies have linked eGFR variability with risk of kidney disease progression, [cardiovascular disease] CVD events and all-cause mortality,” Rakesh Malhotra, MD, MPH, of the University of California, San Diego, and colleagues wrote. “These studies have typically evaluated populations with prevalent chronic kidney disease (CKD) or kidney transplant recipients. A broader evaluation in other high-risk populations, in particular hypertensive patients, is needed to assess the clinical implications of eGFR variability in these settings.”
To this end, researchers included 7,520 individuals aged 50 years or older who had at least one risk factor for CVD (65% were men; 58% were white). All were participants in the Systolic Blood Pressure Intervention Trial, which assessed blood pressure control in patients who had hypertension but not necessarily CKD.
Researchers considered variation of eGFR measurements at 6, 12 and 18 months, and assessed the relationship to a CVD composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure or CVD death) or all-cause mortality from month 18 to the end of follow-up (median follow-up was 2.4 years; mean eGFR at 6 months, 73 mL/min/m2).
Malhotra and colleagues noted 370 CVD events and 154 deaths occurred in the follow-up period.
After adjusting for albuminuria at baseline, eGFR at month 18 and other CVD risk factors, researchers found greater eGFR variability was associated with an increased risk for all-cause mortality (hazard ratio [HR] per standard deviation greater variability was 1.29) but not CVD events (HR = 1.05).
“Associations were similar when stratified by treatment arm and baseline CKD status, when accounting for concurrent systolic BP changes, use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and diuretic medications during follow-up,” the researchers wrote.
Malhotra and colleagues acknowledged some limitations of the study, writing that SPRINT excluded patients with diabetes, stroke and proteinuria greater than 1 g per day.
Despite these limitations, the researchers concluded: “Clinicians should be aware that greater eGFR variability may identify people at higher mortality risk, irrespective of the severity of their kidney function at baseline.”
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