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CKD classification based on estimated GFR over three years and subsequent cardiac and mortality outcomes: a cohort
Daniel E Weiner1, Maria Krassilnikova, Hocine Tighiouart
1Division of Nephrology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA. dweiner@tuftsmedicalcenter.org
Insights
Defining chronic kidney disease (CKD) using one estimated glomerular filtration rate (eGFR) assessment is prognostic. Persistently low eGFR indicates the highest risk for cardiovascular events and mortality.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- The prognostic significance of reduced estimated glomerular filtration rate (eGFR) for chronic kidney disease (CKD) diagnosis using single versus multiple assessments remains unclear in community populations.
- Investigating the impact of diagnostic criteria on predicting adverse outcomes is crucial for patient management.
Purpose of the Study:
- To determine if defining CKD based on one or two eGFR measurements influences the prognostic value of reduced eGFR.
- To assess the association between different eGFR trajectories and cardiovascular events, stroke, and mortality in a community-based cohort.
Main Methods:
- Classified participants from the Atherosclerosis Risk in Communities and Cardiovascular Health Studies into four groups based on two eGFR assessments over approximately 35 months.
- Analyzed outcomes including cardiac events, stroke, and mortality using multivariable Cox models, stratifying by eGFR status: sustained <60 mL/min/1.73 m², increase, decline, or persistently ≥60 mL/min/1.73 m².
- Utilized both standard and CKD-EPI equations for eGFR estimation.
Main Results:
- Sustained eGFR <60 mL/min/1.73 m² was associated with the highest risk of cardiac and composite events (HRs 1.38 and 1.58, respectively).
- eGFR decline also showed increased risk for cardiac and composite events (HRs 1.20 and 1.32, respectively).
- Individuals with eGFR increase showed a trend towards increased cardiac risk (HR 1.25), but results were not statistically significant compared to eGFR decline.
Conclusions:
- Persistently reduced eGFR is linked to the highest risk of cardiovascular outcomes and mortality.
- Even a single eGFR measurement below 60 mL/min/1.73 m² identifies individuals at intermediate risk, suggesting prognostic value for single-point CKD classification.
- These findings support the utility of single eGFR assessments in identifying at-risk individuals within community settings.
Background:
It is unknown whether defining chronic kidney disease (CKD) based on one versus two estimated glomerular filtration rate (eGFR) assessments changes the prognostic importance of reduced eGFR in a community-based population.
Methods:
Participants in the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study were classified into 4 groups based on two eGFR assessments separated by 35.3 +/- 2.5 months: sustained eGFR < 60 mL/min per 1.73 m(2) (1 mL/sec per 1.73 m(2)); eGFR increase (change from below to above 60); eGFR decline (change from above to below 60); and eGFR persistently >or=60. Outcomes assessed in stratified multivariable Cox models included cardiac events and a composite of cardiac events, stroke, and mortality.
Results:
There were 891 (4.9%) participants with sustained eGFR < 60, 278 (1.5%) with eGFR increase, 972 (5.4%) with eGFR decline, and 15,925 (88.2%) with sustained eGFR > 60. Participants with eGFR sustained < 60 were at highest risk of cardiac and composite events [HR = 1.38 (1.15, 1.65) and 1.58 (1.41, 1.77)], respectively, followed by eGFR decline [HR = 1.20 (1.00, 1.45) and 1.32 (1.17, 1.49)]. Individuals with eGFR increase trended toward increased cardiac risk [HR = 1.25 (0.88, 1.77)] and did not significantly differ from eGFR decline for any outcome. Results were similar when estimating GFR with the CKD-EPI equation.
Conclusion:
Individuals with persistently reduced eGFR are at highest risk of cardiovascular outcomes and mortality, while individuals with an eGFR < 60 mL/min per 1.73 m(2) at any time are at intermediate risk. Use of even a single measurement of eGFR to classify CKD in a community population appears to have prognostic value.
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