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First-year estimated glomerular filtration rate variability after pre-end-stage renal disease program enrollment and adverse outcomes of chronic kidney disease.
Nephrol Dial Transplant. 2019 12 01; 34(12):2066-2078.ND

Abstract

BACKGROUND

Scarce evidence associates the first-year estimated glomerular filtration rate (eGFR) variability and longitudinal change scales concomitantly to the risk of developing end-stage renal disease (ESRD), acute coronary syndrome (ACS) and death following pre-ESRD program enrollment in chronic kidney disease (CKD).

METHODS

We conducted a prospective cohort study of 5092 CKD patients receiving multidisciplinary care between 2003 and 2015 with careful ascertainment of ESRD, ACS and death during the follow-up. First-year eGFR variability and longitudinal change scales that were based on all first-year eGFR measurements included coefficient of variation of eGFR (eGFR-CV), percent change (eGFR-PC), absolute difference (eGFR-AD), slope (eGFR-slope) and area under the curve (AUC).

RESULTS

A total of 786 incident ESRD, 292 ACS and 410 death events occurred during the follow-up. In the multiple Cox regression, the fully adjusted hazard ratios (HRs) of progression to ESRD for each unit change in eGFR-CV, eGFR-PC, eGFR-AD, eGFR-slope, eGFR-AUC were 1.03 [95% confidence interval (CI) 1.02-1.04], 1.04 (1.03-1.04), 1.16 (1.14-1.18), 1.16 (1.14-1.17) and 1.04 (1.03-1.04), respectively. The adjusted HRs for incident ESRD comparing the extreme with the reference quartiles of eGFR-CV, eGFR-PC, eGFR-AD, eGFR-slope and eGFR-AUC were 2.67 (95% CI 2.11-3.38), 8.34 (6.33-10.98), 19.08 (11.89-30.62), 13.08 (8.32-20.55) and 6.35 (4.96-8.13), respectively. Similar direction of the effects on the risk of developing ACS and mortality was observed. In the 2 × 2 risk matrices, patients with the highest quartile of eGFR-CV and concomitantly with the most severely declining quartiles of any other longitudinal eGFR change scale had the highest risk of all outcomes.

CONCLUSIONS

The dynamics of eGFR changes, both overall variability and longitudinal changes, over the first year following pre-ESRD program enrollment are crucial prognostic factors for the risk of progression to ESRD, ACS and deaths among patients with CKD. A risk matrix combining the first-year eGFR variability and longitudinal change scales following pre-ESRD enrollment is a novel approach for risk characterization in CKD care. Randomized trials in CKD may be required to ascertain comparable baseline eGFR dynamics.

Authors+Show Affiliations

Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan. School of Medicine, China Medical University, Taichung, Taiwan. Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan. School of Medicine, China Medical University, Taichung, Taiwan.Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan. School of Medicine, China Medical University, Taichung, Taiwan. Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29982714

Citation

Tsai, Ching-Wei, et al. "First-year Estimated Glomerular Filtration Rate Variability After Pre-end-stage Renal Disease Program Enrollment and Adverse Outcomes of Chronic Kidney Disease." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 34, no. 12, 2019, pp. 2066-2078.
Tsai CW, Huang HC, Chiang HY, et al. First-year estimated glomerular filtration rate variability after pre-end-stage renal disease program enrollment and adverse outcomes of chronic kidney disease. Nephrol Dial Transplant. 2019;34(12):2066-2078.
Tsai, C. W., Huang, H. C., Chiang, H. Y., Chung, C. W., Chiu, H. T., Liang, C. C., Yu, T., & Kuo, C. C. (2019). First-year estimated glomerular filtration rate variability after pre-end-stage renal disease program enrollment and adverse outcomes of chronic kidney disease. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 34(12), 2066-2078. https://doi.org/10.1093/ndt/gfy200
Tsai CW, et al. First-year Estimated Glomerular Filtration Rate Variability After Pre-end-stage Renal Disease Program Enrollment and Adverse Outcomes of Chronic Kidney Disease. Nephrol Dial Transplant. 2019 12 1;34(12):2066-2078. PubMed PMID: 29982714.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First-year estimated glomerular filtration rate variability after pre-end-stage renal disease program enrollment and adverse outcomes of chronic kidney disease. AU - Tsai,Ching-Wei, AU - Huang,Han-Chun, AU - Chiang,Hsiu-Yin, AU - Chung,Chih-Wei, AU - Chiu,Hsien-Tsai, AU - Liang,Chih-Chia, AU - Yu,Tsung, AU - Kuo,Chin-Chi, PY - 2018/01/03/received PY - 2018/05/29/accepted PY - 2018/7/10/pubmed PY - 2020/5/1/medline PY - 2018/7/9/entrez KW - chronic kidney disease KW - dialysis KW - eGFR variability KW - mortality KW - trajectory SP - 2066 EP - 2078 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 34 IS - 12 N2 - BACKGROUND: Scarce evidence associates the first-year estimated glomerular filtration rate (eGFR) variability and longitudinal change scales concomitantly to the risk of developing end-stage renal disease (ESRD), acute coronary syndrome (ACS) and death following pre-ESRD program enrollment in chronic kidney disease (CKD). METHODS: We conducted a prospective cohort study of 5092 CKD patients receiving multidisciplinary care between 2003 and 2015 with careful ascertainment of ESRD, ACS and death during the follow-up. First-year eGFR variability and longitudinal change scales that were based on all first-year eGFR measurements included coefficient of variation of eGFR (eGFR-CV), percent change (eGFR-PC), absolute difference (eGFR-AD), slope (eGFR-slope) and area under the curve (AUC). RESULTS: A total of 786 incident ESRD, 292 ACS and 410 death events occurred during the follow-up. In the multiple Cox regression, the fully adjusted hazard ratios (HRs) of progression to ESRD for each unit change in eGFR-CV, eGFR-PC, eGFR-AD, eGFR-slope, eGFR-AUC were 1.03 [95% confidence interval (CI) 1.02-1.04], 1.04 (1.03-1.04), 1.16 (1.14-1.18), 1.16 (1.14-1.17) and 1.04 (1.03-1.04), respectively. The adjusted HRs for incident ESRD comparing the extreme with the reference quartiles of eGFR-CV, eGFR-PC, eGFR-AD, eGFR-slope and eGFR-AUC were 2.67 (95% CI 2.11-3.38), 8.34 (6.33-10.98), 19.08 (11.89-30.62), 13.08 (8.32-20.55) and 6.35 (4.96-8.13), respectively. Similar direction of the effects on the risk of developing ACS and mortality was observed. In the 2 × 2 risk matrices, patients with the highest quartile of eGFR-CV and concomitantly with the most severely declining quartiles of any other longitudinal eGFR change scale had the highest risk of all outcomes. CONCLUSIONS: The dynamics of eGFR changes, both overall variability and longitudinal changes, over the first year following pre-ESRD program enrollment are crucial prognostic factors for the risk of progression to ESRD, ACS and deaths among patients with CKD. A risk matrix combining the first-year eGFR variability and longitudinal change scales following pre-ESRD enrollment is a novel approach for risk characterization in CKD care. Randomized trials in CKD may be required to ascertain comparable baseline eGFR dynamics. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/29982714/First_year_estimated_glomerular_filtration_rate_variability_after_pre_end_stage_renal_disease_program_enrollment_and_adverse_outcomes_of_chronic_kidney_disease_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfy200 DB - PRIME DP - Unbound Medicine ER -