title: Short-term change in eGFR and risk of cardiovascular events.
abstract: BACKGROUND
  Lower estimated glomerular filtration rate (eGFR) on a single occasion is associated with risk of cardiovascular events; whether the degree of change in eGFR during a 1-year period adds prognostic information is unknown.
  
  
  RESULTS
  We included adults who had ≥2 outpatient eGFR measurements (≥6 months apart) during a 1-year accrual period in Alberta, Canada. According to recent guidelines, we used a change in eGFR category (≥90, 60 to 89, 45 to 59, 30 to 44, 15 to 29, and <15 mL/min per 1.73 m(2)), and the presence/absence of a ≥25% change from baseline to classify participants into 5 groups: certain drop, uncertain drop, stable (no change), uncertain rise, and certain rise. We calculated adjusted rates of cardiovascular events (per 10 000 person-years) for each group. We estimated the adjusted risks of cardiovascular events associated with each category of change in eGFR, in reference to stable kidney function. Among the 526 388 participants, 76.1% (n=400 560) had stable, 2.6% (n=13 668) had a certain drop, and 3.3% (n=17 499) had a certain rise in eGFR. Compared with participants with stable kidney function, adjusted risks of myocardial infarction, heart failure, and stroke were 27%, 51%, and 20% higher, respectively, for those with a certain drop in kidney function. After adjusting for the last eGFR at the end of the accrual period, the observed association diminished.
  
  
  CONCLUSIONS
  Clinically relevant changes in eGFR are associated with increased risk of cardiovascular events. However, most of the apparent increase in risk can be accounted for by assessing comorbidity and baseline kidney function.
authors.affiliation: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada (T.C.T.) Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.) Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.).
authors.forename: Tanvir Chowdhury
authors.initials: TC
authors.lastname: Turin
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.) Department of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.J., M.J., B.J.M., B.R.H.) Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.) Institute of Public Health, University of Calgary, Calgary, Alberta, Canada (M.T.J., B.J.M., B.R.H.).
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.J., M.J., B.J.M., B.R.H.).
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada (M.T.).
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.).
authors.forename: Joseph
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.) Department of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.J., M.J., B.J.M., B.R.H.) Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.) Institute of Public Health, University of Calgary, Calgary, Alberta, Canada (M.T.J., B.J.M., B.R.H.).
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.) Department of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.J., M.J., B.J.M., B.R.H.) Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada (T.C.T., M.T.J., B.J.M., B.R.H.) Institute of Public Health, University of Calgary, Calgary, Alberta, Canada (M.T.J., B.J.M., B.R.H.).
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Canada; cardiovascular diseases; clinical epidemiology; kidney function; short‐term change