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Past Decline Versus Current eGFR and Subsequent Mortality Risk

Authors
 David M.J. Naimark  ;  Morgan E. Grams  ;  Kunihiro Matsushita  ;  Corri Black  ;  Iefke Drion  ;  Caroline S. Fox  ;  Lesley A. Inker  ;  Areef Ishani  ;  Sun Ha Jee  ;  Akihiko Kitamura  ;  Janice P. Lea  ;  Joseph Nally  ;  Carmen Alicia Peralta  ;  Dietrich Rothenbacher  ;  Seungho Ryu  ;  Marcello Tonelli  ;  Hiroshi Yatsuya  ;  Josef Coresh  ;  Ron T. Gansevoort  ;  David G. Warnock  ;  Mark Woodward  ;  Paul E. de Jong 
Citation
 JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol.27(8) : 2456-2466, 2016 
Journal Title
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
ISSN
 1046-6673 
Issue Date
2016
MeSH
Aged ; Cause of Death ; Female ; Glomerular Filtration Rate* ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Renal Insufficiency, Chronic/mortality* ; Renal Insufficiency, Chronic/physiopathology* ; Risk Factors ; Time Factors
Keywords
chronic kidney disease ; epidemiology ; glomerular filtration rate ; mortality ; outcomes
Abstract
A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope <-5 ml/min per 1.73 m(2) per year, whereas 7% and 4% had a slope >5 ml/min per 1.73 m(2) per year, respectively. Compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m(2) per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus <3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.
Full Text
http://jasn.asnjournals.org/content/27/8/2456.long
DOI
10.1681/ASN.2015060688
Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Jee, Sun Ha(지선하) ORCID logo https://orcid.org/0000-0001-9519-3068
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152829
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