TY - JOUR
T1 - Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality
AU - Xie, Yan
AU - Bowe, Benjamin
AU - Xian, Hong
AU - Balasubramanian, Sumitra
AU - Al-Aly, Ziyad
N1 - Funding Information:
Support: This work was funded by a grant from the US Department of Veterans Affairs (for Dr Al-Aly). The contents do not represent the views of the US Department of Veterans Affairs or the US Government. The funder of this study had no role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.
Publisher Copyright:
© 2016
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background Estimated glomerular filtration rate (eGFR) trajectories of people entering chronic kidney disease (CKD) stage 4 and their associations with subsequent kidney disease outcomes or death are not known. Study Design Longitudinal observational cohort study. Setting & Participants 26,246 patients in the Veterans Affairs Healthcare System who entered CKD stage 4 in fiscal year 2008 followed up until October 2013. Factors 5-year eGFR trajectories, demographic and health characteristics. Outcomes Composite kidney disease outcome of kidney failure, dialysis therapy or transplantation, and death. Results Latent class group modeling and functional characterization suggest the presence of 3 distinct trajectory classes: class 1 (72%), consistent slow decline with absolute eGFR change of −2.45 (IQR, −3.89 to −1.16) mL/min/1.73 m2 per year; class 2 (18%), consistent fast decline and eGFR change of −8.60 (IQR, −11.29 to −6.66) mL/min/1.73 m2 per year; and class 3 (10%), early nondecline and late fast decline with eGFR change of −0.4 mL/min/1.73 m2 per year in years 1 to 3 and −7.98 and −21.36 mL/min/1.73 m2 per year in years 4 and 5, respectively. During 4.34 years of follow-up, 9,809 (37%) patients had the composite kidney disease outcome and 14,550 (55%) patients died. Compared to the referent group (trajectory class 1), HRs for 1-year risk for composite kidney disease outcome for trajectory classes 2 and 3 were 1.13 (95% CI, 1.05-1.22) and 0.67 (95% CI, 0.59-0.75), whereas HRs for 1-year risk for death for classes 2 and 3 were 1.17 (95% CI, 1.10-1.28) and 1.29 (95% CI, 1.18-1.42), respectively. The 1-year risk for composite kidney disease outcome was 32% and was 42% more likely than the risk for death in trajectory classes 1 and 2, respectively, whereas the risk for death was 67% more likely than the risk for composite kidney disease outcome in trajectory class 3. Limitations Inclusion criteria and mostly male participants limit generalizability of study results. Conclusions We characterized 3 different eGFR trajectory classes of people entering CKD stage 4. Our results suggest that the pattern of eGFR trajectory informs the risk for kidney disease outcomes and death.
AB - Background Estimated glomerular filtration rate (eGFR) trajectories of people entering chronic kidney disease (CKD) stage 4 and their associations with subsequent kidney disease outcomes or death are not known. Study Design Longitudinal observational cohort study. Setting & Participants 26,246 patients in the Veterans Affairs Healthcare System who entered CKD stage 4 in fiscal year 2008 followed up until October 2013. Factors 5-year eGFR trajectories, demographic and health characteristics. Outcomes Composite kidney disease outcome of kidney failure, dialysis therapy or transplantation, and death. Results Latent class group modeling and functional characterization suggest the presence of 3 distinct trajectory classes: class 1 (72%), consistent slow decline with absolute eGFR change of −2.45 (IQR, −3.89 to −1.16) mL/min/1.73 m2 per year; class 2 (18%), consistent fast decline and eGFR change of −8.60 (IQR, −11.29 to −6.66) mL/min/1.73 m2 per year; and class 3 (10%), early nondecline and late fast decline with eGFR change of −0.4 mL/min/1.73 m2 per year in years 1 to 3 and −7.98 and −21.36 mL/min/1.73 m2 per year in years 4 and 5, respectively. During 4.34 years of follow-up, 9,809 (37%) patients had the composite kidney disease outcome and 14,550 (55%) patients died. Compared to the referent group (trajectory class 1), HRs for 1-year risk for composite kidney disease outcome for trajectory classes 2 and 3 were 1.13 (95% CI, 1.05-1.22) and 0.67 (95% CI, 0.59-0.75), whereas HRs for 1-year risk for death for classes 2 and 3 were 1.17 (95% CI, 1.10-1.28) and 1.29 (95% CI, 1.18-1.42), respectively. The 1-year risk for composite kidney disease outcome was 32% and was 42% more likely than the risk for death in trajectory classes 1 and 2, respectively, whereas the risk for death was 67% more likely than the risk for composite kidney disease outcome in trajectory class 3. Limitations Inclusion criteria and mostly male participants limit generalizability of study results. Conclusions We characterized 3 different eGFR trajectory classes of people entering CKD stage 4. Our results suggest that the pattern of eGFR trajectory informs the risk for kidney disease outcomes and death.
KW - Chronic kidney disease (CKD)
KW - comorbid conditions
KW - concordant
KW - dialysis
KW - discordant
KW - disease progression
KW - eGFR trajectories
KW - end-stage renal disease (ESRD)
KW - estimated glomerular filtration rate (eGFR)
KW - kidney disease outcomes
KW - kidney failure
KW - kidney function trajectory
KW - mortality
KW - rate of kidney function decline
KW - renal function trajectory
KW - renal outcomes
KW - stage 4 CKD
KW - transplant
KW - viral infections
UR - http://www.scopus.com/inward/record.url?scp=84959300968&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2016.02.039
DO - 10.1053/j.ajkd.2016.02.039
M3 - Article
C2 - 26948835
AN - SCOPUS:84959300968
SN - 0272-6386
VL - 68
SP - 219
EP - 228
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -