Slope of Kidney Function and Its Association with Longitudinal Mortality and Cardiovascular Disease among Individuals with CKD
| Autor: | James H. Sondheimer, Xue Wang, Raymond R. Townsend, Cric Study Investigators, Wei Yang, L. Lee Hamm, Rajat Deo, Jordana B. Cohen, Krishna Kallem, Paula Orlandi, Jiang He, Sarah J. Schrauben, Dawei Xie, Ana C. Ricardo, Harold I. Feldman, Amanda H. Anderson, Dominic S. Raj, Afshin Parsa |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty 030232 urology & nephrology Renal function Disease 030204 cardiovascular system & hematology Sensitivity and Specificity Cohort Studies 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Renal Insufficiency Chronic Aged Proportional Hazards Models Proportional hazards model business.industry Hazard ratio Confounding General Medicine Middle Aged medicine.disease Confidence interval Survival Rate Nephrology Cardiovascular Diseases Sarcopenia Cohort Cardiology Female business Glomerular Filtration Rate |
| Zdroj: | Journal of the American Society of Nephrology : JASN. 31(12) |
| ISSN: | 1533-3450 |
| Popis: | Background Slopes of eGFR have been associated with increased risks of death and cardiovascular events in a U-shaped fashion. Poor outcomes in individuals with rising eGFR are potentially attributable to sarcopenia, hemodilution, and other indicators of clinical deterioration. Methods To investigate the association between eGFR slopes and risks of death or cardiovascular events, accounting for multiple confounders, we studied 2738 individuals with moderate to severe CKD participating in the multicenter Chronic Renal Insufficiency Cohort (CRIC) Study. We used linear, mixed-effects models to estimate slopes with up to four annual eGFR assessments, and Cox proportional hazards models to investigate the association between slopes and the risks of death and cardiovascular events. Results Slopes of eGFR had a bell-shaped distribution (mean [SD], -1.5 [-2] ml/min per 1.73 m2 per year). Declines of eGFR that were steeper than the average decline associated with progressively increasing risks of death (hazard ratio [HR], 1.23; 95% confidence interval [95% CI], 1.09 to 1.39; for a slope 1 SD below the average) and cardiovascular events (HR, 1.19; 95% CI, 1.03 to 1.38). Rises of eGFR or declines lower than the average decline were not associated with the risk of death or cardiovascular events. Conclusions In a cohort of individuals with moderate to severe CKD, we observed steep declines of eGFR were associated with progressively increasing risks of death and cardiovascular events; however, we found no increased risks associated with eGFR improvement. These findings support the potential value of eGFR slopes in clinical assessment of adults with CKD. |
| Databáze: | OpenAIRE |
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