TY - JOUR AU - Matsushita K. AU - Ballew S. AU - Levin A. AU - Stengel B. AU - Woodward Mark AU - Iseki K. AU - Levey A. AU - Coresh J. AU - Kovesdy C. AU - Rothenbacher D. AU - Naimark D. AU - Nally J. AB -

eGFR is a robust predictor of ESRD risk. However, the prognostic information gained from the past trajectory (slope) beyond that of the current eGFR is unclear. We examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD. We modeled hazard ratios as a spline function of slopes, adjusting for demographic variables, eGFR, and comorbidities. We used random effects meta-analyses to combine results across studies stratified by cohort type. We calculated the absolute risk of ESRD at 5 years after the last eGFR using the weighted average baseline risk. Overall, 1,080,223 participants experienced 5163 ESRD events during a mean follow-up of 2.0 years. In CKD cohorts, a slope of -6 versus 0 ml/min per 1.73 m2 per year over the previous 3 years (a decline of 18 ml/min per 1.73 m2 versus no decline) associated with an adjusted hazard ratio of ESRD of 2.28 (95% confidence interval, 1.88 to 2.76). In contrast, a current eGFR of 30 versus 50 ml/min per 1.73 m2 (a difference of 20 ml/min per 1.73 m2) associated with an adjusted hazard ratio of 19.9 (95% confidence interval, 13.6 to 29.1). Past decline contributed more to the absolute risk of ESRD at lower than higher levels of current eGFR. In conclusion, during a follow-up of 2 years, current eGFR associates more strongly with future ESRD risk than the magnitude of past eGFR decline, but both contribute substantially to the risk of ESRD, especially at eGFR<30 ml/min per 1.73 m2.

AD - Department of Medicine, Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee; Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ckdpc@jhmi.edu.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia;
Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;
Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany;
Institut National de la Sante et de la Recherche Medicale (Inserm) Unite mixte de recherche 1018 - UMR1018) Center for Research in Epidemiology and Population Health, Villejuif, France; UMRS 1018, Paris-Sud University and Versailles Saint Quentin University, Villejuif, France;
Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan; and.
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts. AN - 26657867 BT - Journal of the American Society of Nephrology DP - NLM ET - 2015/12/15 LA - Eng LB - AUS
UK
PROF
FY16 N1 - Kovesdy, Csaba P
Coresh, Josef
Ballew, Shoshana H
Woodward, Mark
Levin, Adeera
Naimark, David M J
Nally, Joseph
Rothenbacher, Dietrich
Stengel, Benedicte
Iseki, Kunitoshi
Matsushita, Kunihiro
Levey, Andrew S
CKD Prognosis Consortium
J Am Soc Nephrol. 2015 Dec 11. pii: ASN.2015060687. N2 -

eGFR is a robust predictor of ESRD risk. However, the prognostic information gained from the past trajectory (slope) beyond that of the current eGFR is unclear. We examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD. We modeled hazard ratios as a spline function of slopes, adjusting for demographic variables, eGFR, and comorbidities. We used random effects meta-analyses to combine results across studies stratified by cohort type. We calculated the absolute risk of ESRD at 5 years after the last eGFR using the weighted average baseline risk. Overall, 1,080,223 participants experienced 5163 ESRD events during a mean follow-up of 2.0 years. In CKD cohorts, a slope of -6 versus 0 ml/min per 1.73 m2 per year over the previous 3 years (a decline of 18 ml/min per 1.73 m2 versus no decline) associated with an adjusted hazard ratio of ESRD of 2.28 (95% confidence interval, 1.88 to 2.76). In contrast, a current eGFR of 30 versus 50 ml/min per 1.73 m2 (a difference of 20 ml/min per 1.73 m2) associated with an adjusted hazard ratio of 19.9 (95% confidence interval, 13.6 to 29.1). Past decline contributed more to the absolute risk of ESRD at lower than higher levels of current eGFR. In conclusion, during a follow-up of 2 years, current eGFR associates more strongly with future ESRD risk than the magnitude of past eGFR decline, but both contribute substantially to the risk of ESRD, especially at eGFR<30 ml/min per 1.73 m2.

PY - 2015 SN - 1533-3450 (Electronic)
1046-6673 (Linking) T2 - Journal of the American Society of Nephrology TI - Past Decline Versus Current eGFR and Subsequent ESRD Risk Y2 - FY16 ER -