CKD classification based on estimated GFR over three years and subsequent cardiac and mortality outcomes: a cohort study

Autor: Maria Krassilnikova, Daniel E. Weiner, Andrew S. Levey, Deeb N. Salem, Hocine Tighiouart, Mark J. Sarnak
Rok vydání: 2009
Předmět:
Nephrology
Male
medicine.medical_specialty
Population
Renal function
Comorbidity
030204 cardiovascular system & hematology
urologic and male genital diseases
lcsh:RC870-923
Risk Assessment
Sensitivity and Specificity
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Medicine
Humans
030212 general & internal medicine
education
Survival rate
Survival analysis
Aged
Aged
80 and over
education.field_of_study
urogenital system
business.industry
Incidence
Reproducibility of Results
Middle Aged
medicine.disease
lcsh:Diseases of the genitourinary system. Urology
Atherosclerosis
Survival Analysis
female genital diseases and pregnancy complications
Stroke
Survival Rate
Kidney Failure
Chronic
Female
business
Kidney disease
Cohort study
Boston
Glomerular Filtration Rate
Research Article
Zdroj: BMC Nephrology
BMC Nephrology, Vol 10, Iss 1, p 26 (2009)
ISSN: 1471-2369
Popis: Background It is unknown whether defining chronic kidney disease (CKD) based on one versus two estimated glomerular filtration rate (eGFR) assessments changes the prognostic importance of reduced eGFR in a community-based population. Methods Participants in the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study were classified into 4 groups based on two eGFR assessments separated by 35.3 ± 2.5 months: sustained eGFR < 60 mL/min per 1.73 m2 (1 mL/sec per 1.73 m2); eGFR increase (change from below to above 60); eGFR decline (change from above to below 60); and eGFR persistently ≥60. Outcomes assessed in stratified multivariable Cox models included cardiac events and a composite of cardiac events, stroke, and mortality. Results There were 891 (4.9%) participants with sustained eGFR < 60, 278 (1.5%) with eGFR increase, 972 (5.4%) with eGFR decline, and 15,925 (88.2%) with sustained eGFR > 60. Participants with eGFR sustained < 60 were at highest risk of cardiac and composite events [HR = 1.38 (1.15, 1.65) and 1.58 (1.41, 1.77)], respectively, followed by eGFR decline [HR = 1.20 (1.00, 1.45) and 1.32 (1.17, 1.49)]. Individuals with eGFR increase trended toward increased cardiac risk [HR = 1.25 (0.88, 1.77)] and did not significantly differ from eGFR decline for any outcome. Results were similar when estimating GFR with the CKD-EPI equation. Conclusion Individuals with persistently reduced eGFR are at highest risk of cardiovascular outcomes and mortality, while individuals with an eGFR < 60 mL/min per 1.73 m2 at any time are at intermediate risk. Use of even a single measurement of eGFR to classify CKD in a community population appears to have prognostic value.
Databáze: OpenAIRE
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