Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality
Identifieur interne : 003A64 ( Main/Exploration ); précédent : 003A63; suivant : 003A65Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality
Auteurs : 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 P. Kovesdy ; Angharad Marks ; Takayoshi Ohkubo ; Varda Shalev ; Anoop Shankar ; Chi Pang Wen ; Paul E. De Jong ; Kunitoshi Iseki ; Benedicte Stengel ; Ron T. Gansevoort ; Andrew S. LeveySource :
- JAMA [ 0098-7484 ] ; 2014.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Créatinine (sang), Défaillance rénale chronique (mortalité), Défaillance rénale chronique (physiopathologie), Détermination du point final, Femelle, Humains, Mâle, Risque, Sujet âgé, Sujet âgé de 80 ans ou plus, Taux de filtration glomérulaire, Valeurs de référence, Études de cohortes, Évolution de la maladie.
- MESH :
- mortalité : Défaillance rénale chronique.
- physiopathologie : Défaillance rénale chronique.
- sang : Créatinine.
- Adulte, Adulte d'âge moyen, Détermination du point final, Femelle, Humains, Mâle, Risque, Sujet âgé, Sujet âgé de 80 ans ou plus, Taux de filtration glomérulaire, Valeurs de référence, Études de cohortes, Évolution de la maladie.
English descriptors
- KwdEn :
- MESH :
- chemical , blood : Creatinine.
- mortality : Kidney Failure, Chronic.
- physiopathology : Kidney Failure, Chronic.
- Adult, Aged, Aged, 80 and over, Cohort Studies, Disease Progression, Endpoint Determination, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Reference Values, Risk.
Abstract
The established chronic kidney disease (CKD) progression endpoint, end-stage renal disease (ESRD) or doubling of serum creatinine (corresponding to a change in estimated glomerular filtration rate (eGFR) of −57% or greater) is a late event, limiting feasibility of nephrology clinical trials.
To characterize the association of decline in eGFR with subsequent progression to ESRD, with implications for using lesser declines in eGFR as potential alternative endpoints for CKD progression. Since most people with CKD die before reaching ESRD, we also investigated mortality risk.
Individual meta-analysis of up to 1.7 million participants with 12,344 ESRD events and 223,944 deaths from 35 cohorts.
Cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine over 1-3 years and outcome data.
Transfer of individual participant data or standardized analysis of outputs for random effects meta-analysis took place between July 2012 and September 2013 with baseline eGFRs during 1975-2012.
ESRD (initiation of dialysis or transplantation) or all-cause mortality risk related to percent change in eGFR over 2 years adjusted for potential confounders and first eGFR.
The adjusted hazard ratios (HR) of ESRD and mortality were exponentially higher with larger eGFR decline. Among participants with baseline eGFR <60 ml/min/1.73m2, the adjusted HRs for ESRD were 32.1 (95% CI 22.3-46.3) and 5.4 (4.5-6.4) for −57% and −30% eGFR changes, respectively. However, changes of −30% or greater were much more common than changes of −57% (6.9% (6.4-7.4%) vs. 0.79% (0.52-1.06%) in the whole consortium). This association was strong and consistent across length of baseline (1 or 3 years), baseline eGFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD for eGFR changes of −57%, −40%, −30% and 0% were 99% (95-100%), 83% (71-93%), 64% (52-77%), vs. 18% (15-22%) respectively at baseline eGFR of 35 ml/min/1.73m2. Corresponding mortality risks were 77% (71-82%), 60% (56-63%), 50% (47-52%), vs. 32% (31-33%), showing a similar but weaker pattern.
Declines in eGFR smaller than doubling of serum creatinine occur more commonly and are strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in eGFR, such as 30% reduction over 2 years, as an alternative endpoint for CKD progression.
Url:
DOI: 10.1001/jama.2014.6634
PubMed: 24892770
PubMed Central: 4172342
Affiliations:
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Ballew</name></author><author><name sortKey="Appel, Lawrence J" sort="Appel, Lawrence J" uniqKey="Appel L" first="Lawrence J." last="Appel">Lawrence J. Appel</name></author><author><name sortKey="Arima, Hisatomi" sort="Arima, Hisatomi" uniqKey="Arima H" first="Hisatomi" last="Arima">Hisatomi Arima</name></author><author><name sortKey="Chadban, Steven J" sort="Chadban, Steven J" uniqKey="Chadban S" first="Steven J." last="Chadban">Steven J. Chadban</name></author><author><name sortKey="Cirillo, Massimo" sort="Cirillo, Massimo" uniqKey="Cirillo M" first="Massimo" last="Cirillo">Massimo Cirillo</name></author><author><name sortKey="Djurdjev, Ognjenka" sort="Djurdjev, Ognjenka" uniqKey="Djurdjev O" first="Ognjenka" last="Djurdjev">Ognjenka Djurdjev</name></author><author><name sortKey="Green, Jamie A" sort="Green, Jamie A" uniqKey="Green J" first="Jamie A" last="Green">Jamie A. Green</name></author><author><name sortKey="Heine, Gunnar H" sort="Heine, Gunnar H" uniqKey="Heine G" first="Gunnar H" last="Heine">Gunnar H. Heine</name></author><author><name sortKey="Inker, Lesley A" sort="Inker, Lesley A" uniqKey="Inker L" first="Lesley A" last="Inker">Lesley A. Inker</name></author><author><name sortKey="Irie, Fujiko" sort="Irie, Fujiko" uniqKey="Irie F" first="Fujiko" last="Irie">Fujiko Irie</name></author><author><name sortKey="Ishani, Areef" sort="Ishani, Areef" uniqKey="Ishani A" first="Areef" last="Ishani">Areef Ishani</name></author><author><name sortKey="Ix, Joachim H" sort="Ix, Joachim H" uniqKey="Ix J" first="Joachim H." last="Ix">Joachim H. Ix</name></author><author><name sortKey="Kovesdy, Csaba P" sort="Kovesdy, Csaba P" uniqKey="Kovesdy C" first="Csaba P." last="Kovesdy">Csaba P. Kovesdy</name></author><author><name sortKey="Marks, Angharad" sort="Marks, Angharad" uniqKey="Marks A" first="Angharad" last="Marks">Angharad Marks</name></author><author><name sortKey="Ohkubo, Takayoshi" sort="Ohkubo, Takayoshi" uniqKey="Ohkubo T" first="Takayoshi" last="Ohkubo">Takayoshi Ohkubo</name></author><author><name sortKey="Shalev, Varda" sort="Shalev, Varda" uniqKey="Shalev V" first="Varda" last="Shalev">Varda Shalev</name></author><author><name sortKey="Shankar, Anoop" sort="Shankar, Anoop" uniqKey="Shankar A" first="Anoop" last="Shankar">Anoop Shankar</name></author><author><name sortKey="Wen, Chi Pang" sort="Wen, Chi Pang" uniqKey="Wen C" first="Chi Pang" last="Wen">Chi Pang Wen</name></author><author><name sortKey="De Jong, Paul E" sort="De Jong, Paul E" uniqKey="De Jong P" first="Paul E." last="De Jong">Paul E. De Jong</name></author><author><name sortKey="Iseki, Kunitoshi" sort="Iseki, Kunitoshi" uniqKey="Iseki K" first="Kunitoshi" last="Iseki">Kunitoshi Iseki</name></author><author><name sortKey="Stengel, Benedicte" sort="Stengel, Benedicte" uniqKey="Stengel B" first="Benedicte" last="Stengel">Benedicte Stengel</name></author><author><name sortKey="Gansevoort, Ron T" sort="Gansevoort, Ron T" uniqKey="Gansevoort R" first="Ron T." last="Gansevoort">Ron T. Gansevoort</name></author><author><name sortKey="Levey, Andrew S" sort="Levey, Andrew S" uniqKey="Levey A" first="Andrew S" last="Levey">Andrew S. Levey</name></author></analytic><series><title level="j">JAMA</title><idno type="ISSN">0098-7484</idno><idno type="eISSN">1538-3598</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Cohort Studies</term><term>Creatinine (blood)</term><term>Disease Progression</term><term>Endpoint Determination</term><term>Female</term><term>Glomerular Filtration Rate</term><term>Humans</term><term>Kidney Failure, Chronic (mortality)</term><term>Kidney Failure, Chronic (physiopathology)</term><term>Male</term><term>Middle Aged</term><term>Reference Values</term><term>Risk</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Créatinine (sang)</term><term>Défaillance rénale chronique (mortalité)</term><term>Défaillance rénale chronique (physiopathologie)</term><term>Détermination du point final</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Risque</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Taux de filtration glomérulaire</term><term>Valeurs de référence</term><term>Études de cohortes</term><term>Évolution de la maladie</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Creatinine</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Kidney Failure, Chronic</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Défaillance rénale chronique</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Défaillance rénale chronique</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Kidney Failure, Chronic</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Créatinine</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Cohort Studies</term><term>Disease Progression</term><term>Endpoint Determination</term><term>Female</term><term>Glomerular Filtration Rate</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Reference Values</term><term>Risk</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Détermination du point final</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Risque</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Taux de filtration glomérulaire</term><term>Valeurs de référence</term><term>Études de cohortes</term><term>Évolution de la maladie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Importance</title><p id="P1">The established chronic kidney disease (CKD) progression endpoint, end-stage renal disease (ESRD) or doubling of serum creatinine (corresponding to a change in estimated glomerular filtration rate (eGFR) of −57% or greater) is a late event, limiting feasibility of nephrology clinical trials.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To characterize the association of decline in eGFR with subsequent progression to ESRD, with implications for using lesser declines in eGFR as potential alternative endpoints for CKD progression. Since most people with CKD die before reaching ESRD, we also investigated mortality risk.</p></sec><sec id="S3"><title>Data Sources</title><p id="P3">Individual meta-analysis of up to 1.7 million participants with 12,344 ESRD events and 223,944 deaths from 35 cohorts.</p></sec><sec id="S4"><title>Study Selection</title><p id="P4">Cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine over 1-3 years and outcome data.</p></sec><sec id="S5"><title>Data Extraction and Synthesis</title><p id="P5">Transfer of individual participant data or standardized analysis of outputs for random effects meta-analysis took place between July 2012 and September 2013 with baseline eGFRs during 1975-2012.</p></sec><sec id="S6"><title>Main Outcomes and Measures</title><p id="P6">ESRD (initiation of dialysis or transplantation) or all-cause mortality risk related to percent change in eGFR over 2 years adjusted for potential confounders and first eGFR.</p></sec><sec id="S7"><title>Results</title><p id="P7">The adjusted hazard ratios (HR) of ESRD and mortality were exponentially higher with larger eGFR decline. Among participants with baseline eGFR <60 ml/min/1.73m<sup>2</sup>, the adjusted HRs for ESRD were 32.1 (95% CI 22.3-46.3) and 5.4 (4.5-6.4) for −57% and −30% eGFR changes, respectively. However, changes of −30% or greater were much more common than changes of −57% (6.9% (6.4-7.4%) vs. 0.79% (0.52-1.06%) in the whole consortium). This association was strong and consistent across length of baseline (1 or 3 years), baseline eGFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD for eGFR changes of −57%, −40%, −30% and 0% were 99% (95-100%), 83% (71-93%), 64% (52-77%), vs. 18% (15-22%) respectively at baseline eGFR of 35 ml/min/1.73m<sup>2</sup>. Corresponding mortality risks were 77% (71-82%), 60% (56-63%), 50% (47-52%), vs. 32% (31-33%), showing a similar but weaker pattern.</p></sec><sec id="S8"><title>Conclusions and Relevance</title><p id="P8">Declines in eGFR smaller than doubling of serum creatinine occur more commonly and are strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in eGFR, such as 30% reduction over 2 years, as an alternative endpoint for CKD progression.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Appel, Lawrence J" sort="Appel, Lawrence J" uniqKey="Appel L" first="Lawrence J." last="Appel">Lawrence J. Appel</name><name sortKey="Arima, Hisatomi" sort="Arima, Hisatomi" uniqKey="Arima H" first="Hisatomi" last="Arima">Hisatomi Arima</name><name sortKey="Ballew, Shoshana H" sort="Ballew, Shoshana H" uniqKey="Ballew S" first="Shoshana H" last="Ballew">Shoshana H. Ballew</name><name sortKey="Chadban, Steven J" sort="Chadban, Steven J" uniqKey="Chadban S" first="Steven J." last="Chadban">Steven J. Chadban</name><name sortKey="Cirillo, Massimo" sort="Cirillo, Massimo" uniqKey="Cirillo M" first="Massimo" last="Cirillo">Massimo Cirillo</name><name sortKey="Coresh, Josef" sort="Coresh, Josef" uniqKey="Coresh J" first="Josef" last="Coresh">Josef Coresh</name><name sortKey="De Jong, Paul E" sort="De Jong, Paul E" uniqKey="De Jong P" first="Paul E." last="De Jong">Paul E. De Jong</name><name sortKey="Djurdjev, Ognjenka" sort="Djurdjev, Ognjenka" uniqKey="Djurdjev O" first="Ognjenka" last="Djurdjev">Ognjenka Djurdjev</name><name sortKey="Gansevoort, Ron T" sort="Gansevoort, Ron T" uniqKey="Gansevoort R" first="Ron T." last="Gansevoort">Ron T. Gansevoort</name><name sortKey="Green, Jamie A" sort="Green, Jamie A" uniqKey="Green J" first="Jamie A" last="Green">Jamie A. Green</name><name sortKey="Heine, Gunnar H" sort="Heine, Gunnar H" uniqKey="Heine G" first="Gunnar H" last="Heine">Gunnar H. Heine</name><name sortKey="Inker, Lesley A" sort="Inker, Lesley A" uniqKey="Inker L" first="Lesley A" last="Inker">Lesley A. Inker</name><name sortKey="Irie, Fujiko" sort="Irie, Fujiko" uniqKey="Irie F" first="Fujiko" last="Irie">Fujiko Irie</name><name sortKey="Iseki, Kunitoshi" sort="Iseki, Kunitoshi" uniqKey="Iseki K" first="Kunitoshi" last="Iseki">Kunitoshi Iseki</name><name sortKey="Ishani, Areef" sort="Ishani, Areef" uniqKey="Ishani A" first="Areef" last="Ishani">Areef Ishani</name><name sortKey="Ix, Joachim H" sort="Ix, Joachim H" uniqKey="Ix J" first="Joachim H." last="Ix">Joachim H. Ix</name><name sortKey="Kovesdy, Csaba P" sort="Kovesdy, Csaba P" uniqKey="Kovesdy C" first="Csaba P." last="Kovesdy">Csaba P. Kovesdy</name><name sortKey="Levey, Andrew S" sort="Levey, Andrew S" uniqKey="Levey A" first="Andrew S" last="Levey">Andrew S. Levey</name><name sortKey="Marks, Angharad" sort="Marks, Angharad" uniqKey="Marks A" first="Angharad" last="Marks">Angharad Marks</name><name sortKey="Matsushita, Kunihiro" sort="Matsushita, Kunihiro" uniqKey="Matsushita K" first="Kunihiro" last="Matsushita">Kunihiro Matsushita</name><name sortKey="Ohkubo, Takayoshi" sort="Ohkubo, Takayoshi" uniqKey="Ohkubo T" first="Takayoshi" last="Ohkubo">Takayoshi Ohkubo</name><name sortKey="Sang, Yingying" sort="Sang, Yingying" uniqKey="Sang Y" first="Yingying" last="Sang">Yingying Sang</name><name sortKey="Shalev, Varda" sort="Shalev, Varda" uniqKey="Shalev V" first="Varda" last="Shalev">Varda Shalev</name><name sortKey="Shankar, Anoop" sort="Shankar, Anoop" uniqKey="Shankar A" first="Anoop" last="Shankar">Anoop Shankar</name><name sortKey="Stengel, Benedicte" sort="Stengel, Benedicte" uniqKey="Stengel B" first="Benedicte" last="Stengel">Benedicte Stengel</name><name sortKey="Turin, Tanvir Chowdhury" sort="Turin, Tanvir Chowdhury" uniqKey="Turin T" first="Tanvir Chowdhury" last="Turin">Tanvir Chowdhury Turin</name><name sortKey="Wen, Chi Pang" sort="Wen, Chi Pang" uniqKey="Wen C" first="Chi Pang" last="Wen">Chi Pang Wen</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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