title: Past Decline Versus Current eGFR and Subsequent ESRD Risk.
abstract: eGFR is a robust predictor of ESRD risk. However, the prognostic information gained from the past trajectory (slope) beyond that of the current eGFR is unclear. We examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD. We modeled hazard ratios as a spline function of slopes, adjusting for demographic variables, eGFR, and comorbidities. We used random effects meta-analyses to combine results across studies stratified by cohort type. We calculated the absolute risk of ESRD at 5 years after the last eGFR using the weighted average baseline risk. Overall, 1,080,223 participants experienced 5163 ESRD events during a mean follow-up of 2.0 years. In CKD cohorts, a slope of -6 versus 0 ml/min per 1.73 m(2) per year over the previous 3 years (a decline of 18 ml/min per 1.73 m(2) versus no decline) associated with an adjusted hazard ratio of ESRD of 2.28 (95% confidence interval, 1.88 to 2.76). In contrast, a current eGFR of 30 versus 50 ml/min per 1.73 m(2) (a difference of 20 ml/min per 1.73 m(2)) associated with an adjusted hazard ratio of 19.9 (95% confidence interval, 13.6 to 29.1). Past decline contributed more to the absolute risk of ESRD at lower than higher levels of current eGFR. In conclusion, during a follow-up of 2 years, current eGFR associates more strongly with future ESRD risk than the magnitude of past eGFR decline, but both contribute substantially to the risk of ESRD, especially at eGFR<30 ml/min per 1.73 m(2).
authors.affiliation: Department of Medicine, Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee; Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
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 Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
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; The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia;
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;
authors.forename: David M J
authors.initials: DM
authors.lastname: Naimark
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;
authors.forename: Joseph
authors.initials: J
authors.lastname: Nally
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany;
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (Inserm) Unité mixte de recherche 1018 - UMR1018) Center for Research in Epidemiology and Population Health, Villejuif, France; UMRS 1018, Paris-Sud University and Versailles Saint Quentin University, Villejuif, France;
authors.forename: Benedicte
authors.initials: B
authors.lastname: Stengel
authors.affiliation: Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan; and.
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
mesh_terms: D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors
keywords: end-stage renal disease; epidemiology and outcomes; glomerular filtration rate; progression of chronic renal failure