BACKGROUND: Kidney half-life and inter-stage progression rates in native chronic kidney disease (CKD) and CKD-transplant (CKD-T) remain unknown. METHODS: We examined stage-to-stage progression/regression rates in patients with CKD (n = 601) and CKD-T (n = 431) between 1991 and 2001. Kidney function was estimated by Cockcroft-Gault and MDRD eGFR formulae. Kaplan-Meier analyses determined progression and regression half-lives, defined as the time required for 50% of kidneys to advance towards a higher or lower stage of CKD, respectively. RESULTS: Most (67%) of the patients were in stage 3. Patients with native CKD were more likely to progress compared to CKD-T (inter-stage progression rates 12 vs 4 cases per 100 patient-years, P < 0.0001). Accordingly, estimated glomerular filtration rate (eGFR)-based progression half-lives were significantly shorter in CKD compared to CKD-T [6 vs 9.6 years, P < 0.0001, hazard ratio (HR) 3.1, 95% confidence interval (CI) = 2.5-3.7]. Creatinine clearance (CCR)-based stage half-lives were 7.2 months shorter in each group (5.4 and 9 years in CKD and CKD-T, respectively). Despite slower progression rates in patients with transplant kidney disease, adjusted patient survival rates were significantly decreased in CKD-T compared to CKD. Only Scr and CCR-based formulae were significantly associated with patient and allograft outcomes in the CKD-T group. Moreover, death rates were not different in stage 3 compared to stage 2 CKD-T, suggesting that eGFR and the current staging classification have a limited value to predict patient death in this cohort. CONCLUSION: Kidney half-lives per stage of CKD may be a novel tool to examine disease progression.
BACKGROUND: Kidney half-life and inter-stage progression rates in native chronic kidney disease (CKD) and CKD-transplant (CKD-T) remain unknown. METHODS: We examined stage-to-stage progression/regression rates in patients with CKD (n = 601) and CKD-T (n = 431) between 1991 and 2001. Kidney function was estimated by Cockcroft-Gault and MDRD eGFR formulae. Kaplan-Meier analyses determined progression and regression half-lives, defined as the time required for 50% of kidneys to advance towards a higher or lower stage of CKD, respectively. RESULTS: Most (67%) of the patients were in stage 3. Patients with native CKD were more likely to progress compared to CKD-T (inter-stage progression rates 12 vs 4 cases per 100 patient-years, P < 0.0001). Accordingly, estimated glomerular filtration rate (eGFR)-based progression half-lives were significantly shorter in CKD compared to CKD-T [6 vs 9.6 years, P < 0.0001, hazard ratio (HR) 3.1, 95% confidence interval (CI) = 2.5-3.7]. Creatinine clearance (CCR)-based stage half-lives were 7.2 months shorter in each group (5.4 and 9 years in CKD and CKD-T, respectively). Despite slower progression rates in patients with transplant kidney disease, adjusted patient survival rates were significantly decreased in CKD-T compared to CKD. Only Scr and CCR-based formulae were significantly associated with patient and allograft outcomes in the CKD-T group. Moreover, death rates were not different in stage 3 compared to stage 2 CKD-T, suggesting that eGFR and the current staging classification have a limited value to predict patient death in this cohort. CONCLUSION: Kidney half-lives per stage of CKD may be a novel tool to examine disease progression.
Authors: D E Weiner; M A Carpenter; A S Levey; A Ivanova; E H Cole; L Hunsicker; B L Kasiske; S J Kim; J W Kusek; A G Bostom Journal: Am J Transplant Date: 2012-05-17 Impact factor: 8.086
Authors: Micah R Chan; Bharvi Oza-Gajera; Kevin Chapla; Arjang X Djamali; Brenda L Muth; Jennifer Turk; Maureen Wakeen; Alexander S Yevzlin; Brad C Astor Journal: Clin J Am Soc Nephrol Date: 2014-06-05 Impact factor: 8.237
Authors: Roberto Marcén; José María Morales; Ana Fernández-Rodriguez; Luis Capdevila; Luis Pallardó; Juan José Plaza; Juan José Cubero; Josep María Puig; Ana Sanchez-Fructuoso; Manual Arias; Gabriela Alperovich; Daniel Serón Journal: NDT Plus Date: 2010-06
Authors: Emily Conley; Brenda Muth; Millie Samaniego; Mary Lotfi; Barbara Voss; Mike Armbrust; John Pirsch; Arjang Djamali Journal: Transplantation Date: 2008-07-27 Impact factor: 4.939