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Results from eGFR associated with increased risk of mortality, ESRD
Results from a routine blood test can help doctors identify the risk of kidney failure or death, according to data from two studies published in the Journal of the American Society of Nephrology.
Researchers from the Chronic Kidney Disease (CKD) Prognosis Consortium found that changes in estimated glomerular filtration rate (eGFR) were associated with an increased risk for mortality and end-stage renal disease (ESRD).
"Patients and physicians should pay attention to the estimates of kidney function which are routinely obtained, but all-too-often ignored," Josef Coresh, MD, the George W. Comstock Professor of Epidemiology at Johns Hopkins Bloomberg School of Public Health, said in a press release. "It costs cents to do this test and it is done all the time. The results can inform treatment decisions that may be able to slow kidney function decline. And while the test is more informative to doctors than a glucose test for diabetes, the results are many times overlooked, particularly when a patient has other chronic illnesses that require more immediate consideration."
Csaba P. Kovesdy , MD, a nephrologist and professor of medicine at the University of Tennessee Health Science Center, and colleagues analyzed data on change in eGFR from 22 participating cohorts.
Data showed that, in a cohort of almost 1.1 million participants, 5,163 experienced ESRD events during the mean follow-up period of 2 years.
In patients with CKD, a slope of 6 vs. 0 ml/min per 1.73 m2 per year over the previous 3 years associated with an adjusted hazard ratio of ESRD of 2.28 (95% CI, 1.88-2.76). Kovesdy and colleagues found that a current eGFR of 30 vs. 50 ml/min per 1.73 m2 was associated with an adjusted hazard ratio of 19.9 (95% CI, 13.6-29.1).
"Although the last eGFR level seems to be a robust predictor of future ESRD, past trajectory of eGFR over time is also independently associated with ESRD and adds significantly to the information provided by the single last eGFR level, especially in patients with lower eGFR in whom risk of progression to ESRD in the near future is greatest," Kovesdy and colleagues concluded. "The ubiquity of electronic medical records makes the evaluation of both single eGFR levels and past slopes of eGFR readily available to increasing numbers of physicians, and their incorporation in everyday clinical practice could improve risk prediction and allow for better strategic resource allocation. The result could be the delivery of better care for later stages of CKD with potential downstream advantages, such as lower ESRD incidence or a more seamless transition to ESRD."
David M.J. Naimark , MD, MSc, FRCP, a nephrologist at Sunnybrook Health Sciences Centre, Toronto and an assistant professor of medicine at the University of Toronto, and colleagues conducted an individual-level meta-analysis of mortality risk associated with eGFR slope in 1.2 million patients from 34 cohorts within the CKD Prognosis Consortium.
Results showed that 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope less than 5 ml/min per 1.73 m2 per year, whereas 7% and 4% had a slope greater than 5 ml/min per 1.73 m2 per year, respectively, in a 3-year antecedent period.
Naimark and colleagues reported that a slope of 6 ml/min per 1.73 m2 per year was associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% CI, 1.09-1.44) in CKD cohorts and 1.15 (95% CI, 1.01-1.31) in other cohorts, compared with a slope of 0 ml/min per 1.73 m2 per year. Additionally, a slope of +6 ml/min per 1.73 m2 per year was associated with higher all–cause mortality risk in CKD cohorts (adjusted HR = 1.58; 95% CI, 1.29-1.95) and in other cohorts (adjusted HR = 1.43; 95% CI, 1.11-1.84).
The researchers reported that results were similar for noncardiovascular and cardiovascular mortality and was stronger for longer antecedent periods.
"Compared with patients with a stable eGFR, those with either an antecedent rise or fall in values were at increased risk of subsequent mortality," Naimark and colleagues wrote. "Prior change of eGFR over 3 years contributed additional information regarding mortality risk beyond the current eGFR itself. However, these incremental risks were clinically meaningful only for large eGFR changes, which were uncommon. Future research could focus on new filtration markers or direct GFR measurement to help elucidate the nature of the relationship between rising eGFR and mortality risk."– by Chelsea Frajerman Pardes
Disclosures: The authors report no relevant financial disclosures.