Journal Article

Change in the estimated glomerular filtration rate over time and risk of all-cause mortality

Turin, Tanvir C., de Jong, Paul E., Tonelli, Marcello, Coresh, Josef, Stevens, Paul E., Hemmelgarn, Brenda R., Matsushita, Kunihiro, Farmer, Christopher K.T.

2013

Overview

Using a community-based cohort we studied the association between changes in the estimated glomerular filtration rate (eGFR) over time and the risk of all-cause mortality. We identified 529,312 adults who had at least three outpatient eGFR measurements over a 4-year period from a provincial laboratory repository in Alberta, Canada. Two indices of change in eGFR were evaluated: the absolute annual rate of change (in ml/min per 1.73m2 per year) and the annual percentage change (percent/year). The adjusted mortality risk associated with each category of change in eGFR was assessed, using stable eGFR (no change) as the reference. Over a median follow-up of 2.5 years there were 32,372 deaths. Compared to the reference participants, those with the greatest absolute annual decline less than or equal to 5ml/min per 1.73m2 per year had significantly increased mortality (hazard ratio of 1.52) adjusted for covariates and kidney function at baseline (last eGFR measurement). Participants with the greatest increase in eGFR of 5ml/min per 1.73m2 per year or more also had significantly increased mortality (adjusted hazard ratio of 2.20). A similar pattern was found when change in eGFR was quantified as an annual percentage change. Thus, both declining and increasing eGFR were independently associated with mortality and underscore the importance of identifying change in eGFR over time to improve mortality risk prediction.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Aged / Alberta - epidemiology / Biomarkers - blood / chronic kidney disease / Cohort Studies / Comorbidity / Creatinine - blood / epidemiology and outcomes / Female / Glomerular Filtration Rate / Humans / Kidney - metabolism / Kidney - physiopathology / Male / Middle Aged / mortality risk / Predictive Value of Tests / Prognosis / Proportional Hazards Models / Renal Insufficiency, Chronic - blood / Renal Insufficiency, Chronic - diagnosis / Renal Insufficiency, Chronic - mortality / Renal Insufficiency, Chronic - physiopathology / Risk Assessment / Risk Factors / Time Factors