title: Renal function trajectory over time and adverse clinical outcomes.
abstract: The growing burden of chronic kidney disease (CKD), with its associated morbidity and mortality, is recognized as a major public health problem globally and causing substantial load on health care systems. The current framework for the definition and staging of CKD, based on eGFR levels or presence of kidney damage, is useful for clinical classification of patients, but identifies a huge number of people as having CKD which is too many to target for intervention. The ability to identify a subset of patients, at high risk for adverse outcomes, would be useful to inform clinical management. The current staging system applies static definitions of kidney function that fail to capture the dynamic nature of the kidney disease over time. Now-a-days, it is possible to capture multiple measurements of different laboratory test results for an individual including eGFR values. A new possibility for identifying individuals at higher risk of adverse outcomes is being explored through assessment and consideration of the rate of change in kidney function over time, and this approach will be feasible in the current context of digitalization of health record keeping system. On the basis of the existing evidence, this paper summarizes important findings that support the concept of dynamic changes in kidney function over time, and discusses how the magnitude of these changes affect the future adverse outcomes of kidney disease, particularly the End Stage Renal Disease (ESRD), CVD and mortality.
authors.affiliation: Centre for Public Health, Queen's University Belfast, Belfast, UK.
authors.forename: Badrul Munir
authors.initials: BM
authors.lastname: Sohel
authors.affiliation: Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
authors.forename: Nahid
authors.initials: N
authors.lastname: Rumana
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Iwate, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohsawa
authors.affiliation: Department of Family Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Tanvir Chowdhury
authors.initials: TC
authors.lastname: Turin
authors.affiliation: Department of Family Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Martina Ann
authors.initials: MA
authors.lastname: Kelly
authors.affiliation: Department of Public Health, General Directorate of Health Affairs in Tabuk Region, Ministry of Health, Tabuk, Kingdom of Saudi Arabia. doctor.mamun@gmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al Mamun
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Adverse outcome; Chronic kidney disease; Renal function change