title: Change in Measured GFR Versus eGFR and CKD Outcomes.
abstract: Measured GFR (mGFR) has long been considered the gold standard measure of kidney function, but recent studies have shown that mGFR is not consistently superior to eGFR in explaining CKD-related comorbidities. The associations between longitudinal changes in mGFR versus eGFR and adverse outcomes have not been examined. We analyzed a subset of 942 participants with CKD in the Chronic Renal Insufficiency Cohort Study who had at least two mGFRs and two eGFRs determined concurrently by iothalamate and creatinine (eGFRcr) or cystatin C, respectively. We compared the associations between longitudinal changes in each measure of kidney function over 2 years and risks of ESRD, nonfatal cardiovascular events, and all-cause mortality using univariate Cox proportional hazards models. The associations for all outcomes except all-cause mortality associated most strongly with longitudinal decline in eGFRcr. Every 5-ml/min per 1.73 m(2) decline in eGFRcr over 2 years associated with 1.54 (95% confidence interval, 1.44 to 1.66; P<0.001) times higher risk of ESRD and 1.23 (95% confidence interval, 1.12 to 1.34; P<0.001) times higher risk for cardiovascular events. All-cause mortality did not associate with longitudinal decline in mGFR or eGFR. When analyzed by tertiles of renal function decline, mGFR did not outperform eGFRcr in the association with any outcome. In conclusion, compared with declines in eGFR, declines in mGFR over a 2-year period, analyzed either as a continuous variable or in tertiles, did not consistently show enhanced association with risk of ESRD, cardiovascular events, or death.
authors.affiliation: Division of Nephrology, Department of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, and elaine.ku@ucsf.edu.
authors.forename: Elaine
authors.initials: E
authors.lastname: Ku
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Division of General Internal Medicine, San Francisco Veterans Affair Medical Center, Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, California;
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hyre Anderson
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Tulane University New Orleans, Louisiana;
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California;
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Departments of Epidemiology and Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center Cleveland, Ohio;
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Horwitz
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center Cleveland, Ohio; Division of Nephrology, Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University, Cleveland, Ohio;
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Department of Medicine, Division of Nephrology, University of Illinois, Chicago, Illinois; and.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: James H
authors.initials: JH
authors.lastname: Sondheimer
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: Division of Nephrology, Department of Medicine, Division of Research, Kaiser Permanente Northern California, Oakland, California;
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*
keywords: chronic renal disease; creatinine clearance; glomerular filtration rate