Slope of Kidney Function and Its Association with Longitudinal Mortality and Cardiovascular Disease among Individuals with CKD.
cardiovascular events
chronic kidney disease
epidemiology and outcomes
glomerular filtration rate
mortality risk
risk factors
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
20
04
2020
accepted:
01
09
2020
pubmed:
8
10
2020
medline:
13
3
2021
entrez:
7
10
2020
Statut:
ppublish
Résumé
Slopes of eGFR have been associated with increased risks of death and cardiovascular events in a U-shaped fashion. Poor outcomes in individuals with rising eGFR are potentially attributable to sarcopenia, hemodilution, and other indicators of clinical deterioration. To investigate the association between eGFR slopes and risks of death or cardiovascular events, accounting for multiple confounders, we studied 2738 individuals with moderate to severe CKD participating in the multicenter Chronic Renal Insufficiency Cohort (CRIC) Study. We used linear, mixed-effects models to estimate slopes with up to four annual eGFR assessments, and Cox proportional hazards models to investigate the association between slopes and the risks of death and cardiovascular events. Slopes of eGFR had a bell-shaped distribution (mean [SD], -1.5 [-2] ml/min per 1.73 m In a cohort of individuals with moderate to severe CKD, we observed steep declines of eGFR were associated with progressively increasing risks of death and cardiovascular events; however, we found no increased risks associated with eGFR improvement. These findings support the potential value of eGFR slopes in clinical assessment of adults with CKD.
Sections du résumé
BACKGROUND
Slopes of eGFR have been associated with increased risks of death and cardiovascular events in a U-shaped fashion. Poor outcomes in individuals with rising eGFR are potentially attributable to sarcopenia, hemodilution, and other indicators of clinical deterioration.
METHODS
To investigate the association between eGFR slopes and risks of death or cardiovascular events, accounting for multiple confounders, we studied 2738 individuals with moderate to severe CKD participating in the multicenter Chronic Renal Insufficiency Cohort (CRIC) Study. We used linear, mixed-effects models to estimate slopes with up to four annual eGFR assessments, and Cox proportional hazards models to investigate the association between slopes and the risks of death and cardiovascular events.
RESULTS
Slopes of eGFR had a bell-shaped distribution (mean [SD], -1.5 [-2] ml/min per 1.73 m
CONCLUSIONS
In a cohort of individuals with moderate to severe CKD, we observed steep declines of eGFR were associated with progressively increasing risks of death and cardiovascular events; however, we found no increased risks associated with eGFR improvement. These findings support the potential value of eGFR slopes in clinical assessment of adults with CKD.
Identifiants
pubmed: 33023926
pii: ASN.2020040476
doi: 10.1681/ASN.2020040476
pmc: PMC7790212
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2912-2923Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000433
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002548
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK061021
Pays : United States
Organisme : NIDDK NIH HHS
ID : U24 DK060990
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK060963
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK118198
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK060980
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000003
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000439
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK060990
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK061028
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR029879
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR024131
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK060984
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000424
Pays : United States
Organisme : NCRR NIH HHS
ID : M01 RR016500
Pays : United States
Organisme : NIGMS NIH HHS
ID : P20 GM109036
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK060902
Pays : United States
Organisme : NIDDK NIH HHS
ID : U01 DK061022
Pays : United States
Organisme : NIDDK NIH HHS
ID : L30 DK110819
Pays : United States
Investigateurs
Lawrence J Appel
(LJ)
Alan S Go
(AS)
James P Lash
(JP)
Panduranga S Rao
(PS)
Mahboob Rahman
(M)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
Références
J Am Soc Nephrol. 2010 Nov;21(11):1961-9
pubmed: 20947634
J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S148-53
pubmed: 12819321
Clin J Am Soc Nephrol. 2011 Aug;6(8):1879-86
pubmed: 21685022
Am J Kidney Dis. 2012 Apr;59(4):513-22
pubmed: 22305760
J Am Soc Nephrol. 2015 Oct;26(10):2504-11
pubmed: 25733525
Arch Intern Med. 2008 Nov 10;168(20):2212-8
pubmed: 19001197
J Am Soc Nephrol. 2012 Apr;23(4):706-13
pubmed: 22402803
Nephrol Dial Transplant. 2017 Jul 1;32(7):1204-1210
pubmed: 27220754
N Engl J Med. 2013 Dec 5;369(23):2183-96
pubmed: 24206458
J Am Soc Nephrol. 2016 Aug;27(8):2447-55
pubmed: 26657867
Am J Kidney Dis. 2012 Aug;60(2):250-61
pubmed: 22658574
J Am Soc Nephrol. 2009 Dec;20(12):2617-24
pubmed: 19892932
Clin J Am Soc Nephrol. 2017 Jul 27;12(8):1357-1365
pubmed: 28751576
Clin J Am Soc Nephrol. 2009 Aug;4(8):1302-11
pubmed: 19541818
Kidney Int. 1997 Jun;51(6):1908-19
pubmed: 9186882
Clin Chem. 2007 Apr;53(4):766-72
pubmed: 17332152
J Am Soc Nephrol. 2016 Nov;27(11):3488-3497
pubmed: 27151925
Circulation. 2012 Feb 7;125(5):677-84
pubmed: 22223429
Clin J Am Soc Nephrol. 2014 Dec 5;9(12):2095-103
pubmed: 25381342
J Am Soc Nephrol. 2006 Jan;17(1):244-53
pubmed: 16291840
Clin J Am Soc Nephrol. 2017 Jan 6;12(1):60-68
pubmed: 28062676
Am J Clin Nutr. 2009 Aug;90(2):407-14
pubmed: 19535427
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Am J Nephrol. 2010;31(5):426-34
pubmed: 20389058
J Am Soc Nephrol. 2016 Aug;27(8):2456-66
pubmed: 26657865
Clin J Am Soc Nephrol. 2017 Jun 7;12(6):893-903
pubmed: 28522656
Nat Rev Nephrol. 2016 Aug;12(8):453-71
pubmed: 27263398
JAMA. 2014 Jun 25;311(24):2518-2531
pubmed: 24892770