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Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality.
Am J Kidney Dis. 2016 Aug; 68(2):219-228.AJ

Abstract

BACKGROUND

Estimated glomerular filtration rate (eGFR) trajectories of people entering chronic kidney disease (CKD) stage 4 and their associations with subsequent kidney disease outcomes or death are not known.

STUDY DESIGN

Longitudinal observational cohort study.

SETTING & PARTICIPANTS

26,246 patients in the Veterans Affairs Healthcare System who entered CKD stage 4 in fiscal year 2008 followed up until October 2013.

FACTORS

5-year eGFR trajectories, demographic and health characteristics.

OUTCOMES

Composite kidney disease outcome of kidney failure, dialysis therapy or transplantation, and death.

RESULTS

Latent class group modeling and functional characterization suggest the presence of 3 distinct trajectory classes: class 1 (72%), consistent slow decline with absolute eGFR change of -2.45 (IQR, -3.89 to -1.16) mL/min/1.73m(2) per year; class 2 (18%), consistent fast decline and eGFR change of -8.60 (IQR, -11.29 to -6.66) mL/min/1.73m(2) per year; and class 3 (10%), early nondecline and late fast decline with eGFR change of -0.4mL/min/1.73m(2) per year in years 1 to 3 and -7.98 and -21.36mL/min/1.73m(2) per year in years 4 and 5, respectively. During 4.34 years of follow-up, 9,809 (37%) patients had the composite kidney disease outcome and 14,550 (55%) patients died. Compared to the referent group (trajectory class 1), HRs for 1-year risk for composite kidney disease outcome for trajectory classes 2 and 3 were 1.13 (95% CI, 1.05-1.22) and 0.67 (95% CI, 0.59-0.75), whereas HRs for 1-year risk for death for classes 2 and 3 were 1.17 (95% CI, 1.10-1.28) and 1.29 (95% CI, 1.18-1.42), respectively. The 1-year risk for composite kidney disease outcome was 32% and was 42% more likely than the risk for death in trajectory classes 1 and 2, respectively, whereas the risk for death was 67% more likely than the risk for composite kidney disease outcome in trajectory class 3.

LIMITATIONS

Inclusion criteria and mostly male participants limit generalizability of study results.

CONCLUSIONS

We characterized 3 different eGFR trajectory classes of people entering CKD stage 4. Our results suggest that the pattern of eGFR trajectory informs the risk for kidney disease outcomes and death.

Authors+Show Affiliations

Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO.Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO.Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO; Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO.Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO.Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO; Division of Nephrology, Department of Medicine, VA Saint Louis Health Care System, Saint Louis, MO; Department of Medicine, Washington University School of Medicine, Saint Louis, MO. Electronic address: zalaly@gmail.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26948835

Citation

Xie, Yan, et al. "Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 2, 2016, pp. 219-228.
Xie Y, Bowe B, Xian H, et al. Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality. Am J Kidney Dis. 2016;68(2):219-228.
Xie, Y., Bowe, B., Xian, H., Balasubramanian, S., & Al-Aly, Z. (2016). Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(2), 219-228. https://doi.org/10.1053/j.ajkd.2016.02.039
Xie Y, et al. Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality. Am J Kidney Dis. 2016;68(2):219-228. PubMed PMID: 26948835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality. AU - Xie,Yan, AU - Bowe,Benjamin, AU - Xian,Hong, AU - Balasubramanian,Sumitra, AU - Al-Aly,Ziyad, Y1 - 2016/03/04/ PY - 2015/11/14/received PY - 2016/02/04/accepted PY - 2016/3/8/entrez PY - 2016/3/8/pubmed PY - 2017/6/1/medline KW - Chronic kidney disease (CKD) KW - comorbid conditions KW - concordant KW - dialysis KW - discordant KW - disease progression KW - eGFR trajectories KW - end-stage renal disease (ESRD) KW - estimated glomerular filtration rate (eGFR) KW - kidney disease outcomes KW - kidney failure KW - kidney function trajectory KW - mortality KW - rate of kidney function decline KW - renal function trajectory KW - renal outcomes KW - stage 4 CKD KW - transplant KW - viral infections SP - 219 EP - 228 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 2 N2 - BACKGROUND: Estimated glomerular filtration rate (eGFR) trajectories of people entering chronic kidney disease (CKD) stage 4 and their associations with subsequent kidney disease outcomes or death are not known. STUDY DESIGN: Longitudinal observational cohort study. SETTING & PARTICIPANTS: 26,246 patients in the Veterans Affairs Healthcare System who entered CKD stage 4 in fiscal year 2008 followed up until October 2013. FACTORS: 5-year eGFR trajectories, demographic and health characteristics. OUTCOMES: Composite kidney disease outcome of kidney failure, dialysis therapy or transplantation, and death. RESULTS: Latent class group modeling and functional characterization suggest the presence of 3 distinct trajectory classes: class 1 (72%), consistent slow decline with absolute eGFR change of -2.45 (IQR, -3.89 to -1.16) mL/min/1.73m(2) per year; class 2 (18%), consistent fast decline and eGFR change of -8.60 (IQR, -11.29 to -6.66) mL/min/1.73m(2) per year; and class 3 (10%), early nondecline and late fast decline with eGFR change of -0.4mL/min/1.73m(2) per year in years 1 to 3 and -7.98 and -21.36mL/min/1.73m(2) per year in years 4 and 5, respectively. During 4.34 years of follow-up, 9,809 (37%) patients had the composite kidney disease outcome and 14,550 (55%) patients died. Compared to the referent group (trajectory class 1), HRs for 1-year risk for composite kidney disease outcome for trajectory classes 2 and 3 were 1.13 (95% CI, 1.05-1.22) and 0.67 (95% CI, 0.59-0.75), whereas HRs for 1-year risk for death for classes 2 and 3 were 1.17 (95% CI, 1.10-1.28) and 1.29 (95% CI, 1.18-1.42), respectively. The 1-year risk for composite kidney disease outcome was 32% and was 42% more likely than the risk for death in trajectory classes 1 and 2, respectively, whereas the risk for death was 67% more likely than the risk for composite kidney disease outcome in trajectory class 3. LIMITATIONS: Inclusion criteria and mostly male participants limit generalizability of study results. CONCLUSIONS: We characterized 3 different eGFR trajectory classes of people entering CKD stage 4. Our results suggest that the pattern of eGFR trajectory informs the risk for kidney disease outcomes and death. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26948835/Estimated_GFR_Trajectories_of_People_Entering_CKD_Stage_4_and_Subsequent_Kidney_Disease_Outcomes_and_Mortality_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)00158-X DB - PRIME DP - Unbound Medicine ER -