Related Experiment Video
Updated: Jun 22, 2025
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Clinical Outcomes in Patients with CKD and Rapid or Non-rapid eGFR Decline: A Report from the DISCOVER CKD
Hiddo Heerspink1, Stephen Nolan2, Juan-Jesus Carrero3
1Department of Clinical Pharmacy and Pharmacology, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. h.j.lambers.heerspink@umcg.nl.
Insights
Rapid estimated glomerular filtration rate (eGFR) decline in chronic kidney disease (CKD) patients is linked to worse outcomes. Identifying factors for rapid eGFR decline can guide proactive management for better patient health.
Area of Science:
- Nephrology
- Clinical Epidemiology
Background:
- Chronic kidney disease (CKD) affects millions globally, with estimated glomerular filtration rate (eGFR) decline being a key indicator of disease progression.
- Understanding factors associated with varying rates of eGFR decline is crucial for effective patient management and outcome prediction.
Purpose of the Study:
- To analyze baseline characteristics and clinical outcomes of patients with CKD experiencing rapid versus non-rapid eGFR decline.
- To identify patient factors associated with rapid eGFR decline in CKD.
Main Methods:
- Retrospective analysis of de-identified data from DISCOVER CKD (NCT04034992) across multiple international databases (2008-2020).
- Included patients with CKD defined by two consecutive eGFR measures <75 mL/min/1.73 m².
- Defined rapid eGFR decline as >4 mL/min/1.73 m²/year at 2 years post-index; assessed outcomes including mortality, kidney failure, MACE, and hospitalization.
Main Results:
- 13.7% of 804,237 eligible CKD patients exhibited rapid eGFR decline.
- Rapid eGFR decline was associated with higher comorbidity burden and medication use.
- Patients with rapid eGFR decline showed significantly greater risk for composite kidney failure or >50% eGFR decline, all-cause mortality, kidney failure alone, MACE, and hospitalization across databases.
Conclusions:
- Rapid eGFR decline is a significant risk factor for adverse outcomes in CKD patients.
- Identifying patient factors linked to rapid eGFR decline is essential for targeted interventions.
- Proactive management strategies informed by these factors may reduce adverse events in CKD.
Introduction:
This analysis examined the baseline characteristics and clinical outcomes of patients with chronic kidney disease (CKD) and rapid or non-rapid estimated glomerular filtration rate (eGFR) decline, using retrospective data from DISCOVER CKD (ClinicalTrials.gov, NCT04034992).
Methods:
Data (2008-2020) were extracted from UK Clinical Practice Research Datalink, US TriNetX, US Limited Claims and Electronic Health Record Dataset, and Japan Medical Data Vision. Patients with CKD (two consecutive eGFR measures < 75 mL/min/1.73 m2 recorded 90-730 days apart) were included. Rapid eGFR decline was defined as an annual decline of > 4 mL/min/1.73 m2 at 2 years post-index; non-rapid eGFR decline was defined as an annual decline of ≤ 4 mL/min/1.73 m2. Clinical outcomes assessed included all-cause mortality, kidney outcomes (composite risk of kidney failure [progression to CKD stage 5] or > 50% eGFR decline, and kidney failure alone), cardiovascular events-including major adverse cardiovascular events (MACE; non-fatal myocardial infarction/stroke and cardiovascular death)-and all-cause hospitalization.
Results:
Across databases, rapid eGFR decline occurred in 13.7% of 804,237 eligible patients. Mean annual eGFR decline ranged between - 6.21 and - 6.86 mL/min/1.73 m2 in patients with rapid eGFR decline versus between - 0.11 and - 0.77 mL/min/1.73 m2 in patients with non-rapid eGFR decline. Rapid eGFR decline was associated with increased comorbidity burden and medication prescriptions. Across databases, the composite risk of kidney failure or > 50% decline in eGFR was significantly greater in patients with rapid versus non-rapid eGFR decline (P < 0.01); all-cause mortality, kidney failure alone, MACE, and all-cause hospitalization each significantly increased in two databases (P < 0.01-0.05).
Conclusion:
Understanding patient factors associated with rapid eGFR decline in patients with CKD may help identify individuals who would benefit from proactive management to minimize the risk of adverse outcomes.
Trial Registration:
ClinicalTrials.gov identifier, NCT04034992.
More Related Videos
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:10Nephrons
01:23Renal Clearance
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
01:02Renal Drug Excretion: Glomerular Filtration
Drugs gain access to the kidney via the renal artery, which progressively branches off into afferent arterioles....