title: Past Decline Versus Current eGFR and Subsequent Mortality Risk.
abstract: A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope <-5 ml/min per 1.73 m(2) per year, whereas 7% and 4% had a slope >5 ml/min per 1.73 m(2) per year, respectively. Compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m(2) per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus <3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.
authors.affiliation: Division of Nephrology, Sunnybrook Health Sciences Centre and Institute of Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;
authors.forename: David M J
authors.initials: DM
authors.lastname: Naimark
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland;
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Institute of Applied Health Science, University of Aberdeen, Aberdeen, United Kingdom;
authors.forename: Corri
authors.initials: C
authors.lastname: Black
authors.affiliation: Diabetes Centre, Isala Clinics, Zwolle, The Netherlands;
authors.forename: Iefke
authors.initials: I
authors.lastname: Drion
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, Center for Population Studies, Framingham, Massachusetts; Division of Endocrinology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts;
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Inker
authors.affiliation: Section of Nephrology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota;
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.affiliation: Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea;
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Jee
authors.affiliation: Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan;
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kitamura
authors.affiliation: Renal Division, Emory University School of Medicine, Atlanta, Georgia;
authors.forename: Janice P
authors.initials: JP
authors.lastname: Lea
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland, Ohio;
authors.forename: Joseph
authors.initials: J
authors.lastname: Nally
authors.affiliation: Department of Medicine, University of California and San Francisco Veterans Affairs Medical Center, San Francisco, California;
authors.forename: Carmen Alicia
authors.initials: CA
authors.lastname: Peralta
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
authors.affiliation: Kangbuk Samsung Hospital, Sunkgyunkwan University School of Medicine, Seoul, Korea;
authors.forename: Seungho
authors.initials: S
authors.lastname: Ryu
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada;
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada;
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuya
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ckdpc@jhmi.edu.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; and The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology*; D012307:Risk Factors; D013997:Time Factors
keywords: chronic kidney disease; epidemiology; glomerular filtration rate; mortality; outcomes