BACKGROUND AND OBJECTIVES: Estimates of the effect of estimated GFR (eGFR) decline on mortality have focused on populations with normal kidney function, or have included limited information on factors previously shown to influence the risk of death among patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively assessed the effect of rate of eGFR decline on survival of patients with CKD receiving primary care through a large integrated health care system in central Pennsylvania between January 1, 2004, and December 31, 2009. RESULTS: A total of 15,465 patients were followed for a median of 3.4 years. Median rates of eGFR change by those in the lower, middle, and upper tertiles of eGFR slope were -4.8, -0.6, and 3.5 ml/min per 1.73 m(2)/yr, respectively. In Cox proportional hazard modeling for time to death, adjusted for baseline proteinuria, changes in nutritional parameters, and episodes of acute kidney injury during follow-up (among other covariates), the hazard ratio for those in the lower (declining) and upper (increasing) eGFR tertiles (relative to the middle, or stable, tertile) was 1.84 and 1.42, respectively. Longitudinal changes in nutritional status as well as episodes of acute kidney injury attenuated the risk only modestly. These findings were consistent across subgroups. CONCLUSIONS: eGFR change over time adds prognostic information to traditional mortality risk predictors among patients with CKD. The utility of incorporating eGFR trends into patient-risk assessment should be further investigated.
BACKGROUND AND OBJECTIVES: Estimates of the effect of estimated GFR (eGFR) decline on mortality have focused on populations with normal kidney function, or have included limited information on factors previously shown to influence the risk of death among patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively assessed the effect of rate of eGFR decline on survival of patients with CKD receiving primary care through a large integrated health care system in central Pennsylvania between January 1, 2004, and December 31, 2009. RESULTS: A total of 15,465 patients were followed for a median of 3.4 years. Median rates of eGFR change by those in the lower, middle, and upper tertiles of eGFR slope were -4.8, -0.6, and 3.5 ml/min per 1.73 m(2)/yr, respectively. In Cox proportional hazard modeling for time to death, adjusted for baseline proteinuria, changes in nutritional parameters, and episodes of acute kidney injury during follow-up (among other covariates), the hazard ratio for those in the lower (declining) and upper (increasing) eGFR tertiles (relative to the middle, or stable, tertile) was 1.84 and 1.42, respectively. Longitudinal changes in nutritional status as well as episodes of acute kidney injury attenuated the risk only modestly. These findings were consistent across subgroups. CONCLUSIONS: eGFR change over time adds prognostic information to traditional mortality risk predictors among patients with CKD. The utility of incorporating eGFR trends into patient-risk assessment should be further investigated.
Authors: Daniel E Weiner; Hocine Tighiouart; Manish G Amin; Paul C Stark; Bonnie MacLeod; John L Griffith; Deeb N Salem; Andrew S Levey; Mark J Sarnak Journal: J Am Soc Nephrol Date: 2004-05 Impact factor: 10.121
Authors: Gary L Myers; W Greg Miller; Josef Coresh; James Fleming; Neil Greenberg; Tom Greene; Thomas Hostetter; Andrew S Levey; Mauro Panteghini; Michael Welch; John H Eckfeldt Journal: Clin Chem Date: 2005-12-06 Impact factor: 8.327
Authors: Lesley A Stevens; Josef Coresh; Christopher H Schmid; Harold I Feldman; Marc Froissart; John Kusek; Jerome Rossert; Frederick Van Lente; Robert D Bruce; Yaping Lucy Zhang; Tom Greene; Andrew S Levey Journal: Am J Kidney Dis Date: 2008-03 Impact factor: 8.860
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Dena E Rifkin; Michael G Shlipak; Ronit Katz; Linda F Fried; David Siscovick; Michel Chonchol; Anne B Newman; Mark J Sarnak Journal: Arch Intern Med Date: 2008-11-10
Authors: David M J Naimark; Morgan E Grams; Kunihiro Matsushita; Corri Black; Iefke Drion; Caroline S Fox; Lesley A Inker; Areef Ishani; Sun Ha Jee; Akihiko Kitamura; Janice P Lea; Joseph Nally; Carmen Alicia Peralta; Dietrich Rothenbacher; Seungho Ryu; Marcello Tonelli; Hiroshi Yatsuya; Josef Coresh; Ron T Gansevoort; David G Warnock; Mark Woodward; Paul E de Jong Journal: J Am Soc Nephrol Date: 2015-12-11 Impact factor: 10.121
Authors: Enayet K Chowdhury; Robyn G Langham; Zanfina Ademi; Alice Owen; Henry Krum; Lindon M H Wing; Mark R Nelson; Christopher M Reid Journal: Clin J Am Soc Nephrol Date: 2015-04-21 Impact factor: 8.237
Authors: Haochang Shou; Jesse Y Hsu; Dawei Xie; Wei Yang; Jason Roy; Amanda H Anderson; J Richard Landis; Harold I Feldman; Afshin Parsa; Christopher Jepson Journal: Clin J Am Soc Nephrol Date: 2017-07-27 Impact factor: 8.237
Authors: Casey M Rebholz; Morgan E Grams; Kunihiro Matsushita; Lesley A Inker; Meredith C Foster; Andrew S Levey; Elizabeth Selvin; Josef Coresh Journal: Clin J Am Soc Nephrol Date: 2015-03-30 Impact factor: 8.237
Authors: Csaba P Kovesdy; Josef Coresh; Shoshana H Ballew; Mark Woodward; Adeera Levin; David M J Naimark; Joseph Nally; Dietrich Rothenbacher; Benedicte Stengel; Kunitoshi Iseki; Kunihiro Matsushita; Andrew S Levey Journal: J Am Soc Nephrol Date: 2015-12-11 Impact factor: 10.121
Authors: Joshua I Barzilay; Barry R Davis; Sara L Pressel; Alokananda Ghosh; Mahboob Rahman; Paula T Einhorn; William C Cushman; Paul K Whelton; Jackson T Wright Journal: Am J Hypertens Date: 2018-04-13 Impact factor: 2.689