Risk Factors for Prognosis in Patients With Severely Decreased GFR

Area of Science:

• Nephrology
• Cardiology
• Epidemiology

Background:

• Patients with advanced chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m² (CKD G4+), represent a vulnerable subgroup with a high risk of adverse outcomes.
• This population often presents with advanced age and multiple comorbidities, potentially confounding the interpretation of risk factor associations.

Purpose of the Study:

• To conduct a meta-analysis identifying risk factors for kidney failure requiring kidney replacement therapy (KRT), cardiovascular disease (CVD) events, and mortality in individuals with CKD G4+.
• To assess the prognostic value of traditional CVD risk factors in this high-risk CKD population.

Main Methods:

• A meta-analysis was performed using data from 28 international cohorts, encompassing 185,024 participants with CKD G4+.
• Risk factors for KRT, CVD events, and death were analyzed using fully adjusted models within the CKD Prognosis Consortium.

Main Results:

• Key risk factors for KRT included time-varying CVD, male sex, Black race, diabetes, lower eGFR, higher albuminuria, and elevated systolic blood pressure. Notably, older age was associated with a decreased risk of KRT.
• Risk factors for CVD events and mortality shared similarities, including male sex, diabetes, lower eGFR, and higher albuminuria. Systolic blood pressure exhibited a U-shaped association with CVD events, while smoking emerged as an additional mortality risk factor.
• Associations between risk factors and outcomes were largely consistent across diverse global cohorts.

Conclusions:

• Established cardiovascular disease risk factors retain significant prognostic value in individuals with advanced CKD (eGFR <30 ml/min/1.73 m²).
• The magnitude of risk estimates for kidney versus cardiovascular outcomes differs, highlighting the complexity of managing this patient group.
• Findings support the need for targeted interventional studies aimed at modifying these risk factors to improve outcomes in high-risk CKD G4+ patients.