Past Decline Versus Current eGFR and Subsequent Mortality Risk

David M J Naimark, Morgan E Grams, Kunihiro Matsushita, Corri Black, Iefke Drion, Caroline S Fox, Lesley A Inker, Areef Ishani, Sun Ha Jee, Akihiko Kitamura, Janice P Lea, Joseph Nally, Carmen Alicia Peralta, Dietrich Rothenbacher, Seungho Ryu, Marcello Tonelli, Hiroshi Yatsuya, Josef Coresh, Ron T Gansevoort, David G WarnockMark Woodward, Paul E de Jong, CKD Prognosis Consortium

Research output: Contribution to journalArticle

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Abstract

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 <-5 ml/min per 1.73 m(2) per year, whereas 7% and 4% had a slope >5 ml/min per 1.73 m(2) per year, respectively. Compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) 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 m(2) 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 <3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.

Original languageEnglish
Pages (from-to)2456-2466
Number of pages11
JournalJournal of the American Society of Nephrology
Volume27
Issue number8
Early online date11 Dec 2015
DOIs
Publication statusPublished - Aug 2016

Keywords

  • chronic kidney disease
  • glomerular filtration rate outcomes
  • mortality
  • epidemiology

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    Naimark, D. M. J., Grams, M. E., Matsushita, K., Black, C., Drion, I., Fox, C. S., Inker, L. A., Ishani, A., Jee, S. H., Kitamura, A., Lea, J. P., Nally, J., Peralta, C. A., Rothenbacher, D., Ryu, S., Tonelli, M., Yatsuya, H., Coresh, J., Gansevoort, R. T., ... CKD Prognosis Consortium (2016). Past Decline Versus Current eGFR and Subsequent Mortality Risk. Journal of the American Society of Nephrology, 27(8), 2456-2466. https://doi.org/10.1681/ASN.2015060688