title: GFR decline and mortality risk among patients with chronic kidney disease.
abstract: OBJECTIVE
  Estimates of the effect of estimated GFR (eGFR) decline on mortality have focused on populations with normal kidney function, or have included limited information on factors previously shown to influence the risk of death among patients with CKD.
  
  
  METHODS
  We retrospectively assessed the effect of rate of eGFR decline on survival of patients with CKD receiving primary care through a large integrated health care system in central Pennsylvania between January 1, 2004, and December 31, 2009.
  
  
  RESULTS
  A total of 15,465 patients were followed for a median of 3.4 years. Median rates of eGFR change by those in the lower, middle, and upper tertiles of eGFR slope were -4.8, -0.6, and 3.5 ml/min per 1.73 m(2)/yr, respectively. In Cox proportional hazard modeling for time to death, adjusted for baseline proteinuria, changes in nutritional parameters, and episodes of acute kidney injury during follow-up (among other covariates), the hazard ratio for those in the lower (declining) and upper (increasing) eGFR tertiles (relative to the middle, or stable, tertile) was 1.84 and 1.42, respectively. Longitudinal changes in nutritional status as well as episodes of acute kidney injury attenuated the risk only modestly. These findings were consistent across subgroups.
  
  
  CONCLUSIONS
  eGFR change over time adds prognostic information to traditional mortality risk predictors among patients with CKD. The utility of incorporating eGFR trends into patient-risk assessment should be further investigated.
authors.affiliation: Henry Hood Center for Health Research, MC-44-00, 100 North Academy Avenue, Danville, PA 17822, USA. rmperkins@geisinger.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Perkins
authors.forename: Ion D
authors.initials: ID
authors.lastname: Bucaloiu
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.forename: Nasrin
authors.initials: N
authors.lastname: Ashouian
authors.forename: James E
authors.initials: JE
authors.lastname: Hartle
authors.forename: Taher
authors.initials: T
authors.lastname: Yahya
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors