Past Decline Versus Current eGFR and Subsequent ESRD Risk.

Area of Science:

• Nephrology
• Epidemiology
• Biostatistics

Background:

• Estimated glomerular filtration rate (eGFR) is a key predictor of end-stage renal disease (ESRD) risk.
• The prognostic value of past eGFR trajectory (slope) relative to current eGFR level for ESRD risk remains unclear.

Purpose of the Study:

• To determine the association of past eGFR slopes and current eGFR levels with subsequent ESRD.
• To compare the prognostic information provided by eGFR slope versus current eGFR level.

Main Methods:

• Examined 22 cohorts comprising over 1 million participants.
• Modeled hazard ratios for ESRD using spline functions of eGFR slopes, adjusting for covariates.
• Utilized random effects meta-analyses to combine results across studies.
• Calculated 5-year absolute ESRD risk based on weighted average baseline risk.

Main Results:

• A significant decline in eGFR over 3 years (e.g., -6 ml/min/1.73 m²/year) was associated with a 2.28-fold increased hazard of ESRD.
• A lower current eGFR (e.g., 30 vs. 50 ml/min/1.73 m²) showed a substantially higher hazard ratio for ESRD (19.9).
• Past eGFR decline contributed more to absolute ESRD risk at lower current eGFR levels.

Conclusions:

• Current eGFR level is a stronger predictor of future ESRD risk than past eGFR decline over a 2-year follow-up.
• Both current eGFR and past eGFR decline are substantial contributors to ESRD risk, particularly when eGFR is below 30 ml/min/1.73 m².