Abstract: SA-PO760
Improvement in Glomerular Filtration Rate Among CKD Patients: Findings from the CRIC Study
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
- Orlandi, Paula Ferreira, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Xie, Dawei, University of Pennsylvania School of Medicine Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania, United States
- Anderson, Amanda Hyre, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Feldman, Harold I., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Group or Team Name
- CRIC Study Investigators
Background
Improvement of eGFR has been observed in approximately 10% of participants in numerous CKD cohorts. Among those with improving eGFR, a counterintuitive association with increased risk of coronary heart disease and death compared to those with stable or slightly declining eGFR has been reported. Sarcopenia, edema, and other indicators of clinical deterioration may be responsible for the increased risk of poor outcomes among subjects with improving eGFR. We aimed to assess the association between slopes of eGFR and time to cardiovascular events and all-cause mortality accounting for many factors potentially confounding this relationship.
Methods
We studied 3024 participants of the CRIC Study, a multi-center cohort of adults with CKD. We performed Cox Proportional Hazards models with time-varying covariates to investigate the association between slopes of eGFR and cardiovascular events and all-cause mortality. Slopes were estimated using linear mixed effects models and were updated whenever a new eGFR was assessed over a median of 9 years. Individuals were characterized according to three groups based on their slope at year 2: decliner (slope<=-2); stable (slope>-2 and <2); improver (slope>=2ml/min/1.73m2).
Results
In the CRIC Study, 327(11%) presented improvement of eGFR, 1045 (34%) were stable, and 1652 (55%) were decliners. Improvers were predominantly male (60%), had lower systolic blood pressure (mean: 118 mmHg), and lower proteinuria (median: 0.09 g/day). In models adjusted for demographics, diabetes, eGFR, proteinuria, systolic blood pressure, fat-free mass, ejection fraction, antihypertensive drugs and other laboratory markers, time-updated improvement of eGFR was associated with increased risk of death compared to stable slopes: HR 1.89 (95%CI: 1.63 -3.22). The risk of death for steep decliners was also significantly higher: HR 1.63 (95%CI: 1.25 - 2.14).
Conclusion
Slopes of eGFR higher than 2ml/min/1.73m2/year were associated with increased risk of death compared to subjects presenting stable slopes of eGFR. This association was not explained by markers of cardiovascular function, body composition, or by a time-updated approach.
Funding
- NIDDK Support