Predictors of declining glomerular filtration rate in a population-based chronic kidney disease cohort

A high percentage of patients with chronic kidney disease has nonprogressive disease. Classification with respect to rate of change in glomerular filtration rate (GFR) would permit a more targeted approach to these patients. The aim of this study was to study predictors of rate of change in GFR in a population-based cohort.

All prevalent patients with chronic kidney disease stage 3 in a well-defined population in Northern Europe between 1994 and 2003 were included. Clinical and biochemical data were collected from primary care and hospital medical records. GFR was estimated from creatinine with the recalibrated Modification of Diet in Renal Disease Study equation. Rate of change in GFR were explored in two-level multivariate linear regression models.

A total of 1,224 patients were included. The mean age (76.5 years) was higher and mean rate of decline in GFR slower (1.5 ml/min/1.73 m(2)/year) than in studies of selected patient groups. A total of 60% of the patients suffered from comorbid conditions, 90% had hypertension. Male gender, diabetes, proteinuria and higher mean arterial pressure were independent predictors of a faster decline in GFR.

The similarity of the identified predictors with those found in clinical trials of more selected patients may indicate the potential for improved treatment of older chronic kidney disease patients with multiple comorbidities by better adherence to existing guidelines.