Abstract: TH-PO1018
Time-Updated eGFR Variability Is Associated with Mortality, Cardiovascular Disease, and ESKD in Patients with CKD: The CRIC Study
Session Information
- CKD: Epidemiology, Risk Factors, and Prevention - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Nishiwaki, Hiroki, University of Illinois Chicago, Chicago, Illinois, United States
- Missikpode, Celestin, University of Illinois Chicago, Chicago, Illinois, United States
- Ricardo, Ana C., University of Illinois Chicago, Chicago, Illinois, United States
- Yang, Wei, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Anderson, Amanda Hyre, Tulane University, New Orleans, Louisiana, United States
- Lash, James P., University of Illinois Chicago, Chicago, Illinois, United States
- Kelly, Tanika, University of Illinois Chicago, Chicago, Illinois, United States
Group or Team Name
- CRIC Study Investigators.
Background
Previous reports have identified increased estimated glomerular filtration rate (eGFR) variability, measured during a single ascertainment window, as a risk factor for CVD and all-cause mortality. We hypothesized that repeated measures of eGFR variability over multiple ascertainment windows would display stronger associations with common CKD sequelae when compared to analysis methods investigating only a single measure.
Methods
To test our hypothesis, we leveraged longitudinal data from 4,224 participants of the Chronic Renal Insufficiency Cohort (CRIC). eGFR variability was estimated as the coefficient of variation of eGFR measured at 3 consecutive annual follow-up visits, starting at baseline and estimated repeatedly in one-year sliding windows. Associations of eGFR variability with all-cause mortality, CVD, and CKD were tested using two statistical models: Cox proportional hazards models that included baseline covariables and eGFR variability measured during the first ascertainment window (baseline model) and marginal structural models that included repeated measures of eGFR variability and covariables (time-updated model).
Results
The 4,224 CKD patients contributed a total of 39,024 person-years of follow-up time, with a median participant follow-up time of 5.9, 6.1, and 8.3 years for CVD, ESKD and all-cause mortality, respectively. In the baseline and time-updated multivariable adjusted analyses, each standard deviation increase in eGFR variability was associated with respective, 1.04-fold (95%CI:0.96-1.13) and 1.78-fold (95%CI:1.50-2.11) increased risks of CVD, 1.08-fold (95%CI:0.99-1.18) and 2.20-fold (95%CI:1.76-2.75) increased risks of ESKD, and 1.15-fold (95%CI:1.08-1.23) and 1.56-fold (95%CI:1.35-1.81) increased risks of all-cause mortality.
Conclusion
Time-updated analyses revealed markedly larger effect sizes compared to the baseline model, highlighting the potentially important role of this measure in common CKD sequelae.
Forrest plots for the association between continuous eGFR variabilities and CVD, ESKD and mortality with baseline and time-updated models.
Funding
- NIDDK Support