Abstract: SA-PO761
First-Year Estimated Glomerular Filtration Rate Variability After Pre-ESRD Program Enrollment and Adverse Outcomes of CKD
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
Authors
- Kuo, Chin-Chi, China Medical University Hospital, Taichung City, Taiwan
- Tsai, Ching-Wei, China Medical University Hospital, Taichung City, N/A, Taiwan
Background
Scarce evidence associates the first-year estimated glomerular filtration rate (eGFR) variability and longitudinal change scales concomitantly to the risk of developing end stage renal disease(ESRD), acute coronary syndrome(ACS), and death following pre-ESRD program enrollment in chronic kidney disease(CKD).
Methods
We conducted a prospective cohort study of 5,092 CKD patients receiving multidisciplinary care between 2003 and 2015 with careful ascertainment of ESRD, ACS, and death during the follow-up. First-year eGFR dynamics included coefficient of variation (eGFR-CV), percent change (eGFR-PC), absolute difference (eGFR-AD), slope (eGFR-slope), and area under curve (AUC).
Results
A total of 786 incident ESRD, 292 ACS, and 410 death events occurred during the follow-up. In the multiple Cox regression, the fully adjusted HRs for incident ESRD comparing the extreme with the reference quartiles of eGFR-CV, eGFR-PC, eGFR-AD, eGFR-slope, and eGFR-AUC were 2.67(95% CI, 2.11, 3.38), 8.34(6.33, 10.98), 19.08(11.89, 30.62), 13.08(8.32, 20.55), and 6.35(4.96, 8.13), respectively. Similar effects on the risk of developing ACS and mortality was observed. In the 2x2 risk matrices, patients with the highest quartile of eGFR-CV and concomitantly with the most severely declining quartiles of any other longitudinal eGFR change scale had the highest risk of all outcomes.
Conclusion
The dynamics of eGFR changes, both overall variability and longitudinal changes, over the first year following pre-ESRD program enrollment are crucial prognostic factors for the risk of progression to ESRD, ACS and deaths among patients with CKD. A risk matrix combining the first-year eGFR variability and longitudinal change scales following pre-ESRD enrollment is a novel approach for risk characterization in CKD care.
Risk matrices demonstrating the adjusted hazard ratios (aHRs) for ESRD requiring dialysis, ACS, and all-cause mortality by using eGFR-CV (in quartiles) and other scales of eGFR longitudinal change scales, namely eGFR-PC, AD, slope, and AUC.