02374nas a2200361   4500000000100000008004100001100001800042700001100060700001500071700001400086700001500100700001800115700001100133700001600144700001300160700001800173700001500191700001400206700001300220700001500233700002000248700001300268700001500281700001300296700001300309700001100322700001500333700001100348245006700359250001500426520152000441020005101961       2015                            d1 aMatsushita K.1 aJee S.1 aYatsuya H.1 aIshani A.1 aWarnock D.1 aWoodward Mark1 aFox C.1 aKitamura A.1 aBlack C.1 aGansevoort R.1 aTonelli M.1 aCoresh J.1 aInker L.1 ade Jong P.1 aRothenbacher D.1 aGrams M.1 aNaimark D.1 aNally J.1 aDrion I.1 aLea J.1 aPeralta C.1 aRyu S.00aPast Decline Versus Current eGFR and Subsequent Mortality Risk  a2015/12/153 a<p>
A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope &lt;-5 ml/min per 1.73 m2 per year, whereas 7% and 4% had a slope &gt;5 ml/min per 1.73 m2 per year, respectively. Compared with a slope of 0 ml/min per 1.73 m2 per year, a slope of -6 ml/min per 1.73 m2 per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m2 per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus &lt;3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.
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