Kidney Week

Abstract: SA-PO757

Predicting Incidence of CKD G3+ (eGFR <60 mL/min/1.73 m2) in the General Population

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Author

• Nelson, Robert G., CKD Prognosis Consortium (CKD-PC), Baltimore, Maryland, United States

Robert G. Nelson,

Group or Team Name

• CKD Prognosis Consortium

Background

Risk-based treatment strategies are one method of delivering personalized medicine. Valid risk scores are needed for the prediction of CKD G3+, which may prompt albuminuria testing in those who are not already advised to undergo screening because of diabetes, hypertension, or history of cardiovascular disease (CVD).

Methods

Among 26 general population and high-risk population cohorts (N=2.1 million participants) with eGFR ≥60 ml/min/1.73 m², we estimated risk factors of incident eGFR <60 ml/min/1.73 m² (CKD G3+) and eGFR <30 ml/min/1.73 m² (CKD G4+). We derived a risk score using random-effects meta-analyzed sub-hazard ratios from all cohorts, and random-effects meta-analyzed re-fit subhazards from the six cohorts with frequent creatinine measurements. Risk factors evaluated included age, sex, race, baseline eGFR, history of CVD, diabetes, smoking status, hypertension, and body-mass index. Albuminuria was modeled in people with and without diabetes separately due to differences in data availability.

Results

Mean age of participants was 54 years, 53% were female, and mean baseline eGFR was 91 ml/min/1.73 m². Over a mean follow-up of 4.5 years, there were 152,968 events of incident eGFR <60 ml/min/1.73 m² and 31,631 events of incident eGFR <30 ml/min/1.73 m². All risk factors listed in the methods were statistically significant. Applying the risk score to NHANES 2011-2016, the 10th and 90th percentiles of 5-year risk of incident eGFR <60 ml/min/1.73 m² were 0.04% and 3.7% for those aged 18-39 years, 0.6% and 21.9% for 40-59 years, 6.9% and 64.4% for 60-79 years, and 29.3% and 84.6% for ≥80 years. Corresponding estimates of incident eGFR <30 ml/min/1.73 m² were 0.01% and 0.02%, 0.09% and 1.3%, 0.6% and 5.1%, and 1.4% and 7.8%, respectively. Specific equations for patients with diabetes as well as incorporating albuminuria, when measured, provide better personalization.

Conclusion

A risk score for CKD incidence developed from risk factors available in electronic health records had a 10-100 fold risk gradient and could help guide screening and prevention.

Funding

• NIDDK Support