Morgan E Grams1, Aditya Surapaneni1, Lawrence J Appel1, James P Lash2, Jesse Hsu3, Clarissa J Diamantidis4, Sylvia E Rosas5, Jeffrey C Fink6, Julia J Scialla4,7, James Sondheimer8, Chi-Yuan Hsu9, Alfred K Cheung10, Bernard G Jaar1, Sankar Navaneethan11, Debbie L Cohen3, Sarah Schrauben3, Dawei Xie3, Pandu Rao12, Harold I Feldman3. 1. Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD, USA. 2. Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA. 3. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. School of Medicine, Duke University, Durham, NC, USA. 5. Joslin Diabetes Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. 6. Department of Medicine, University of Maryland, Baltimore, MD, USA. 7. Department of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA. 8. Department of Internal Medicine, Wayne State University, Detroit, MI, USA. 9. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. 10. Veterans Affairs Salt Lake City Health Care System, University of Utah, Salt Lake City, UT, USA. 11. Baylor College of Medicine, Houston, TX, USA. 12. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Patients with chronic kidney disease (CKD) face risks of not only end-stage kidney disease (ESKD), cardiovascular disease (CVD) and death, but also decline in kidney function, quality of life (QOL) and mental and physical well-being. This study describes the multidimensional trajectories of CKD using clinical events, kidney function and patient-reported outcome measures (PROMs). We hypothesized that more advanced CKD stages would associate with more rapid decline in each outcome. METHODS: Among 3939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, we evaluated multidimensional disease trajectories by G- and A-stages of enrollment estimated glomerular filtration rate (eGFR) and albuminuria, respectively. These trajectories included clinical events (ESKD, CVD, heart failure and death), eGFR decline and PROMs [kidney disease QOL (KDQOL) burden, effects and symptoms questionnaires, as well as the 12-item short form mental and physical component summaries]. We also evaluated a group-based multitrajectory model to group participants on the basis of longitudinal PROMs and compared group assignments by enrollment G- and A-stage. RESULTS: The mean participant age was 58 years, 45% were women, mean baseline eGFR was 44 mL/min/1.73 m2 and median urine albumin:creatinine ratio was 52 mg/g. The incidence of all clinical events was greater and eGFR decline was faster with more advanced G- and A-stages. While baseline KDQOL and physical component measures were lower with more advanced G- and A-stage of CKD, changes in PROMs were inconsistently related to the baseline CKD stage. Groups formed on PROM trajectories were fairly distinct from existing CKD staging (observed agreement 60.6%) and were associated with the risk of ESKD, CVD, heart failure and death. CONCLUSIONS: More advanced baseline CKD stage was associated with a higher risk of clinical events and faster eGFR decline, and was only weakly related to changes in patient-reported metrics over time.
BACKGROUND: Patients with chronic kidney disease (CKD) face risks of not only end-stage kidney disease (ESKD), cardiovascular disease (CVD) and death, but also decline in kidney function, quality of life (QOL) and mental and physical well-being. This study describes the multidimensional trajectories of CKD using clinical events, kidney function and patient-reported outcome measures (PROMs). We hypothesized that more advanced CKD stages would associate with more rapid decline in each outcome. METHODS: Among 3939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, we evaluated multidimensional disease trajectories by G- and A-stages of enrollment estimated glomerular filtration rate (eGFR) and albuminuria, respectively. These trajectories included clinical events (ESKD, CVD, heart failure and death), eGFR decline and PROMs [kidney disease QOL (KDQOL) burden, effects and symptoms questionnaires, as well as the 12-item short form mental and physical component summaries]. We also evaluated a group-based multitrajectory model to group participants on the basis of longitudinal PROMs and compared group assignments by enrollment G- and A-stage. RESULTS: The mean participant age was 58 years, 45% were women, mean baseline eGFR was 44 mL/min/1.73 m2 and median urine albumin:creatinine ratio was 52 mg/g. The incidence of all clinical events was greater and eGFR decline was faster with more advanced G- and A-stages. While baseline KDQOL and physical component measures were lower with more advanced G- and A-stage of CKD, changes in PROMs were inconsistently related to the baseline CKD stage. Groups formed on PROM trajectories were fairly distinct from existing CKD staging (observed agreement 60.6%) and were associated with the risk of ESKD, CVD, heart failure and death. CONCLUSIONS: More advanced baseline CKD stage was associated with a higher risk of clinical events and faster eGFR decline, and was only weakly related to changes in patient-reported metrics over time.
Authors: Kirsten S Dorans; Julie A Wright Nunes; Douglas E Schaubel; Daohang Sha; Sarah J Schrauben; Robert G Nelson; Panduranga S Rao; Debbie L Cohen; Lawrence J Appel; James P Lash; Mahboob Rahman; Harold I Feldman Journal: Kidney360 Date: 2022-05-24