Estimated GFR Trajectories of People Entering CKD Stage 4 and Subsequent Kidney Disease Outcomes and Mortality

Yan Xie, Benjamin Bowe, Hong Xian, Sumitra Balasubramanian, Ziyad Al-Aly

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)219-228
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume68
Issue number2
DOIs
StatePublished - Aug 1 2016

Keywords

  • Chronic kidney disease (CKD)
  • comorbid conditions
  • concordant
  • dialysis
  • discordant
  • disease progression
  • eGFR trajectories
  • end-stage renal disease (ESRD)
  • estimated glomerular filtration rate (eGFR)
  • kidney disease outcomes
  • kidney failure
  • kidney function trajectory
  • mortality
  • rate of kidney function decline
  • renal function trajectory
  • renal outcomes
  • stage 4 CKD
  • transplant
  • viral infections

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