title: Deterioration, improvement of kidney function over time and determinants in the Cape Town Bellville South cohort.
abstract: OBJECTIVE
  The aim of the present study was to assess the trajectories of glomerular filtration rate (GFR) and determinants of change during a 3-year period in free-living mixed-ancestry South Africans.
  
  
  METHODS
  In all 320 (78.1% women) adults, aged 56.2 years, from Cape Town were examined in 2008 and 2011. Estimated glomerular filtration rate (eGFR) was based on the Modification of Diet in Renal Disease model; and staging of eGFR used the National Kidney Foundation's classification.
  
  
  RESULTS
  Mean eGFR (mL/min per 1.73 m2) was 68.6 at baseline and eGFR stages were: > 90 (9.4%), 60-90 (58.7%), 30-60 (28.1%) and < 30 (0.9%). eGFR increased by 8 mL/min during follow-up, reflecting variable trajectories by baseline eGFR stages, sex, hypertension and glucose tolerance (all P-interaction ≤ 0.012). Movements across eGFR stages during follow-up favoured improvement in 113 participants (35.3%), and worsened in 23 (7.2%). In adjusted multinomial logistic regressions, men had a 72% (43-86%) lower chance of improvement, while each mmHg higher systolic blood pressure conferred a 7% (3-11%) risk of deterioration. Equivalent for each 1% HbA1c was 30% (8-56%). Participants with glucose intolerance had 102% (3-297%) higher chances of improvement than diabetics.
  
  
  CONCLUSIONS
  Variable trajectories of eGFR with time were observed in this cohort, reflecting the effects of modifiable risk factors such as hypertension and dysglycaemia.
authors.affiliation: Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa.
authors.forename: Tandi E
authors.initials: TE
authors.lastname: Matsha
authors.forename: David J
authors.initials: DJ
authors.lastname: Soita
authors.forename: Shafick M
authors.initials: SM
authors.lastname: Hassan
authors.forename: Rajiv T
authors.initials: RT
authors.lastname: Erasmus
authors.forename: Andre P
authors.initials: AP
authors.lastname: Kengne
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014504:Urban Health
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: South Africa; blood pressure; glucose tolerance; kidney function; progression; risk factor