Past Decline Versus Current eGFR and Subsequent Mortality Risk.

Area of Science:

• Nephrology
• Epidemiology
• Public Health

Background:

• A single estimated Glomerular Filtration Rate (eGFR) measurement is linked to mortality risk.
• The association between prior eGFR decline and mortality risk remains uncertain.
• Understanding eGFR trends is crucial for predicting patient outcomes.

Purpose of the Study:

• To investigate the association between antecedent eGFR slope and subsequent mortality risk.
• To determine if eGFR trends, independent of current eGFR, predict mortality.
• To analyze mortality risk across different eGFR slopes in CKD and non-CKD cohorts.

Main Methods:

• Individual-level meta-analysis of 1.2 million subjects from 12 CKD and 22 other cohorts.
• Analysis of eGFR slope over a 3-year antecedent period, adjusting for established risk factors including last eGFR.
• Follow-up duration of 3.2 years to assess all-cause mortality.

Main Results:

• A decline of -6 ml/min/1.73 m²/year in eGFR associated with increased mortality (aHR 1.25 in CKD cohorts, 1.15 in other cohorts).
• An increase of +6 ml/min/1.73 m²/year in eGFR also associated with increased mortality (aHR 1.58 in CKD cohorts, 1.43 in other cohorts).
• These associations were consistent for cardiovascular and non-cardiovascular deaths and strengthened with longer antecedent periods.

Conclusions:

• Prior decline or rise in eGFR independently associates with increased all-cause mortality risk.
• eGFR slope is a significant predictor of mortality, beyond the level of current eGFR.
• Monitoring eGFR trends is vital for comprehensive risk assessment in diverse populations.