title: Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality.
abstract: BACKGROUND
  Estimated glomerular filtration rate (eGFR) trajectories of people entering chronic kidney disease (CKD) stage 4 and their associations with subsequent kidney disease outcomes or death are not known.
  
  
  METHODS
  Longitudinal observational cohort study.
  
  
  METHODS
  26,246 patients in the Veterans Affairs Healthcare System who entered CKD stage 4 in fiscal year 2008 followed up until October 2013.
  
  
  METHODS
  5-year eGFR trajectories, demographic and health characteristics.
  
  
  RESULTS
  Composite kidney disease outcome of kidney failure, dialysis therapy or transplantation, and death.
  
  
  RESULTS
  Latent class group modeling and functional characterization suggest the presence of 3 distinct trajectory classes: class 1 (72%), consistent slow decline with absolute eGFR change of -2.45 (IQR, -3.89 to -1.16) mL/min/1.73m(2) per year; class 2 (18%), consistent fast decline and eGFR change of -8.60 (IQR, -11.29 to -6.66) mL/min/1.73m(2) per year; and class 3 (10%), early nondecline and late fast decline with eGFR change of -0.4mL/min/1.73m(2) per year in years 1 to 3 and -7.98 and -21.36mL/min/1.73m(2) per year in years 4 and 5, respectively. During 4.34 years of follow-up, 9,809 (37%) patients had the composite kidney disease outcome and 14,550 (55%) patients died. Compared to the referent group (trajectory class 1), HRs for 1-year risk for composite kidney disease outcome for trajectory classes 2 and 3 were 1.13 (95% CI, 1.05-1.22) and 0.67 (95% CI, 0.59-0.75), whereas HRs for 1-year risk for death for classes 2 and 3 were 1.17 (95% CI, 1.10-1.28) and 1.29 (95% CI, 1.18-1.42), respectively. The 1-year risk for composite kidney disease outcome was 32% and was 42% more likely than the risk for death in trajectory classes 1 and 2, respectively, whereas the risk for death was 67% more likely than the risk for composite kidney disease outcome in trajectory class 3.
  
  
  CONCLUSIONS
  Inclusion criteria and mostly male participants limit generalizability of study results.
  
  
  CONCLUSIONS
  We characterized 3 different eGFR trajectory classes of people entering CKD stage 4. Our results suggest that the pattern of eGFR trajectory informs the risk for kidney disease outcomes and death.
authors.affiliation: Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bowe
authors.affiliation: Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO; Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO.
authors.forename: Hong
authors.initials: H
authors.lastname: Xian
authors.affiliation: Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO.
authors.forename: Sumitra
authors.initials: S
authors.lastname: Balasubramanian
authors.affiliation: Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, MO; Division of Nephrology, Department of Medicine, VA Saint Louis Health Care System, Saint Louis, MO; Department of Medicine, Washington University School of Medicine, Saint Louis, MO. Electronic address: zalaly@gmail.com.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Al-Aly
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology*; D012720:Severity of Illness Index
keywords: Chronic kidney disease (CKD); comorbid conditions; concordant; dialysis; discordant; disease progression; eGFR trajectories; end-stage renal disease (ESRD); estimated glomerular filtration rate (eGFR); kidney disease outcomes; kidney failure; kidney function trajectory; mortality; rate of kidney function decline; renal function trajectory; renal outcomes; stage 4 CKD; transplant; viral infections