Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality

Josef Coresh, Tanvir Chowdhury Turin, Kunihiro Matsushita, Yingying Sang, Shoshana H. Ballew, Lawrence J. Appel, Hisatomi Arima, Steven J. Chadban, Massimo Cirillo, Ognjenka Djurdjev, Jamie A. Green, Gunnar H. Heine, Lesley A. Inker, Fujiko Irie, Areef Ishani, Joachim H. Ix, Csaba Kovesdy, Angharad Marks, Takayoshi Ohkubo, Varda ShalevAnoop Shankar, Chi Pang Wen, Paul E. De Jong, Kunitoshi Iseki, Benedicte Stengel, Ron T. Gansevoort, Andrew S. Levey

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE: The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of -57% or greater) is a late event. OBJECTIVE: To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. DATA SOURCES AND STUDY SELECTION: Individual meta-analysis of 1.7 million participants with 12 344 ESRD events and 223 944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. DATA EXTRACTION AND SYNTHESIS: Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. MAIN OUTCOMES AND MEASURES: End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. RESULTS: The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of -57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of -30%. However, changes of -30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of -57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99% (95% CI, 95%-100%) for estimated GFR change of -57%, was 83% (95% CI, 71%-93%) for estimated GFR change of -40%, and was 64% (95% CI, 52%-77%) for estimated GFR change of -30% vs 18% (95% CI, 15%-22%) for estimated GFR change of 0%. Corresponding mortality risks were 77% (95% CI, 71%-82%), 60% (95% CI, 56%-63%), and 50% (95% CI, 47%-52%) vs 32% (95% CI, 31%-33%), showing a similar but weaker pattern. CONCLUSIONS AND RELEVANCE: Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.

Original languageEnglish (US)
Pages (from-to)2518-2531
Number of pages14
JournalJAMA - Journal of the American Medical Association
Volume311
Issue number24
DOIs
StatePublished - Jan 1 2014

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Glomerular Filtration Rate
Chronic Kidney Failure
Mortality
Chronic Renal Insufficiency
Disease Progression
Creatinine
Meta-Analysis
Serum
Albuminuria
Information Storage and Retrieval
Dialysis

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. / Coresh, Josef; Turin, Tanvir Chowdhury; Matsushita, Kunihiro; Sang, Yingying; Ballew, Shoshana H.; Appel, Lawrence J.; Arima, Hisatomi; Chadban, Steven J.; Cirillo, Massimo; Djurdjev, Ognjenka; Green, Jamie A.; Heine, Gunnar H.; Inker, Lesley A.; Irie, Fujiko; Ishani, Areef; Ix, Joachim H.; Kovesdy, Csaba; Marks, Angharad; Ohkubo, Takayoshi; Shalev, Varda; Shankar, Anoop; Wen, Chi Pang; De Jong, Paul E.; Iseki, Kunitoshi; Stengel, Benedicte; Gansevoort, Ron T.; Levey, Andrew S.

In: JAMA - Journal of the American Medical Association, Vol. 311, No. 24, 01.01.2014, p. 2518-2531.

Research output: Contribution to journalArticle

Coresh, J, Turin, TC, Matsushita, K, Sang, Y, Ballew, SH, Appel, LJ, Arima, H, Chadban, SJ, Cirillo, M, Djurdjev, O, Green, JA, Heine, GH, Inker, LA, Irie, F, Ishani, A, Ix, JH, Kovesdy, C, Marks, A, Ohkubo, T, Shalev, V, Shankar, A, Wen, CP, De Jong, PE, Iseki, K, Stengel, B, Gansevoort, RT & Levey, AS 2014, 'Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality', JAMA - Journal of the American Medical Association, vol. 311, no. 24, pp. 2518-2531. https://doi.org/10.1001/jama.2014.6634
Coresh, Josef ; Turin, Tanvir Chowdhury ; Matsushita, Kunihiro ; Sang, Yingying ; Ballew, Shoshana H. ; Appel, Lawrence J. ; Arima, Hisatomi ; Chadban, Steven J. ; Cirillo, Massimo ; Djurdjev, Ognjenka ; Green, Jamie A. ; Heine, Gunnar H. ; Inker, Lesley A. ; Irie, Fujiko ; Ishani, Areef ; Ix, Joachim H. ; Kovesdy, Csaba ; Marks, Angharad ; Ohkubo, Takayoshi ; Shalev, Varda ; Shankar, Anoop ; Wen, Chi Pang ; De Jong, Paul E. ; Iseki, Kunitoshi ; Stengel, Benedicte ; Gansevoort, Ron T. ; Levey, Andrew S. / Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. In: JAMA - Journal of the American Medical Association. 2014 ; Vol. 311, No. 24. pp. 2518-2531.
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abstract = "IMPORTANCE: The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of -57{\%} or greater) is a late event. OBJECTIVE: To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. DATA SOURCES AND STUDY SELECTION: Individual meta-analysis of 1.7 million participants with 12 344 ESRD events and 223 944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. DATA EXTRACTION AND SYNTHESIS: Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. MAIN OUTCOMES AND MEASURES: End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. RESULTS: The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95{\%} CI, 22.3-46.3) for changes of -57{\%} in estimated GFR and 5.4 (95{\%} CI, 4.5-6.4) for changes of -30{\%}. However, changes of -30{\%} or greater (6.9{\%} [95{\%} CI, 6.4{\%}-7.4{\%}] of the entire consortium) were more common than changes of -57{\%} (0.79{\%} [95{\%} CI, 0.52{\%}-1.06{\%}]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99{\%} (95{\%} CI, 95{\%}-100{\%}) for estimated GFR change of -57{\%}, was 83{\%} (95{\%} CI, 71{\%}-93{\%}) for estimated GFR change of -40{\%}, and was 64{\%} (95{\%} CI, 52{\%}-77{\%}) for estimated GFR change of -30{\%} vs 18{\%} (95{\%} CI, 15{\%}-22{\%}) for estimated GFR change of 0{\%}. Corresponding mortality risks were 77{\%} (95{\%} CI, 71{\%}-82{\%}), 60{\%} (95{\%} CI, 56{\%}-63{\%}), and 50{\%} (95{\%} CI, 47{\%}-52{\%}) vs 32{\%} (95{\%} CI, 31{\%}-33{\%}), showing a similar but weaker pattern. CONCLUSIONS AND RELEVANCE: Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30{\%} reduction over 2 years) as an alternative end point for CKD progression.",
author = "Josef Coresh and Turin, {Tanvir Chowdhury} and Kunihiro Matsushita and Yingying Sang and Ballew, {Shoshana H.} and Appel, {Lawrence J.} and Hisatomi Arima and Chadban, {Steven J.} and Massimo Cirillo and Ognjenka Djurdjev and Green, {Jamie A.} and Heine, {Gunnar H.} and Inker, {Lesley A.} and Fujiko Irie and Areef Ishani and Ix, {Joachim H.} and Csaba Kovesdy and Angharad Marks and Takayoshi Ohkubo and Varda Shalev and Anoop Shankar and Wen, {Chi Pang} and {De Jong}, {Paul E.} and Kunitoshi Iseki and Benedicte Stengel and Gansevoort, {Ron T.} and Levey, {Andrew S.}",
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TY - JOUR

T1 - Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality

AU - Coresh, Josef

AU - Turin, Tanvir Chowdhury

AU - Matsushita, Kunihiro

AU - Sang, Yingying

AU - Ballew, Shoshana H.

AU - Appel, Lawrence J.

AU - Arima, Hisatomi

AU - Chadban, Steven J.

AU - Cirillo, Massimo

AU - Djurdjev, Ognjenka

AU - Green, Jamie A.

AU - Heine, Gunnar H.

AU - Inker, Lesley A.

AU - Irie, Fujiko

AU - Ishani, Areef

AU - Ix, Joachim H.

AU - Kovesdy, Csaba

AU - Marks, Angharad

AU - Ohkubo, Takayoshi

AU - Shalev, Varda

AU - Shankar, Anoop

AU - Wen, Chi Pang

AU - De Jong, Paul E.

AU - Iseki, Kunitoshi

AU - Stengel, Benedicte

AU - Gansevoort, Ron T.

AU - Levey, Andrew S.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - IMPORTANCE: The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of -57% or greater) is a late event. OBJECTIVE: To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. DATA SOURCES AND STUDY SELECTION: Individual meta-analysis of 1.7 million participants with 12 344 ESRD events and 223 944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. DATA EXTRACTION AND SYNTHESIS: Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. MAIN OUTCOMES AND MEASURES: End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. RESULTS: The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of -57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of -30%. However, changes of -30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of -57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99% (95% CI, 95%-100%) for estimated GFR change of -57%, was 83% (95% CI, 71%-93%) for estimated GFR change of -40%, and was 64% (95% CI, 52%-77%) for estimated GFR change of -30% vs 18% (95% CI, 15%-22%) for estimated GFR change of 0%. Corresponding mortality risks were 77% (95% CI, 71%-82%), 60% (95% CI, 56%-63%), and 50% (95% CI, 47%-52%) vs 32% (95% CI, 31%-33%), showing a similar but weaker pattern. CONCLUSIONS AND RELEVANCE: Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.

AB - IMPORTANCE: The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of -57% or greater) is a late event. OBJECTIVE: To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. DATA SOURCES AND STUDY SELECTION: Individual meta-analysis of 1.7 million participants with 12 344 ESRD events and 223 944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. DATA EXTRACTION AND SYNTHESIS: Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. MAIN OUTCOMES AND MEASURES: End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. RESULTS: The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of -57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of -30%. However, changes of -30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of -57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99% (95% CI, 95%-100%) for estimated GFR change of -57%, was 83% (95% CI, 71%-93%) for estimated GFR change of -40%, and was 64% (95% CI, 52%-77%) for estimated GFR change of -30% vs 18% (95% CI, 15%-22%) for estimated GFR change of 0%. Corresponding mortality risks were 77% (95% CI, 71%-82%), 60% (95% CI, 56%-63%), and 50% (95% CI, 47%-52%) vs 32% (95% CI, 31%-33%), showing a similar but weaker pattern. CONCLUSIONS AND RELEVANCE: Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.

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