Higher eGFR variability predicts increased risk of death, dementia, disability, CVD events
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Greater eGFR variability predicts an increased risk of death, dementia, disability and CVD events among older and healthy adults, according to data published in Kidney Medicine.
Further, these associations remain regardless of chronic kidney disease status.
“Utilizing isolated eGFR measures to establish prognosis in older adults is problematic given that eGFR declines even in healthy aging. In patients with multiple comorbidities, studies have linked eGFR variability with increased risk of poor health outcomes. The prognostic significance of eGFR variability in healthy, older adults is unclear,” Michelle A. Fravel, PharmD, from the department of pharmacy practice and science in the College of Pharmacy at The University of Iowa, and colleagues wrote.
In a post-hoc analysis of 12,549 participants of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, researchers explored the relationship between eGFR variability and survival free of dementia or physical disability and CVD events. No participants were diagnosed with dementia, major physical disabilities, previous CVD or any other major life-limiting illness.
In the ASPREE trial, participants consumed 100-mg daily aspirin vs. placebo between 2010 and 2017. Researchers measured serum creatinine and urine albumin-to-creatinine ratios at baseline and at annual visits in years 3, 5 and “closeout.” Additionally, eGFR was measured at baseline, annual visits one and two, then treated as a continuous variable throughout the study. Participants were categorized into tertiles of eGFR with those in the lowest tertile included in the analysis.
A total of 838 participants died, developed dementia or developed a persistent physical disability after a median follow-up of 2.7 years, whereas 379 participants experienced a CVD event.
Compared with the lowest tertile of eGFR variability, researchers observed a 35% increased risk of a composite of death, dementia or physical disability, and a 37% increased risk of CVD events in the highest tertile after adjusting for covariates. Further, these correlations were in participants with and those without CKD at baseline.
“In the present analysis, we found that generally healthy older adults with higher variability in eGFR were less likely to survive free of dementia or persistent physical disability, and more likely to experience a CVD event during follow-up than those with lower variability in eGFR. These associations were found to be independent of baseline kidney function and were consistent across different analytic approaches. Risk of death or dementia or physical disability increased 11% and risk of cardiovascular events increased 9% with each 3 mL/min/1.73 m2 difference in standard deviation of eGFR,” Fravel and colleagues wrote. “Our findings suggest it may be important to monitor variation in eGFR over time in healthy older adults, as a novel predictor of the risk of future poor health outcomes.”
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