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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Past Decline Versus Current eGFR and Subsequent ESRD Risk</title><author><name sortKey="Kovesdy, Csaba P" sort="Kovesdy, Csaba P" uniqKey="Kovesdy C" first="Csaba P." last="Kovesdy">Csaba P. Kovesdy</name><affiliation><nlm:aff id="aff1">Department of Medicine, Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;</nlm:aff></affiliation></author><author><name sortKey="Coresh, Josef" sort="Coresh, Josef" uniqKey="Coresh J" first="Josef" last="Coresh">Josef Coresh</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation></author><author><name sortKey="Ballew, Shoshana H" sort="Ballew, Shoshana H" uniqKey="Ballew S" first="Shoshana H." last="Ballew">Shoshana H. Ballew</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation><affiliation><nlm:aff id="aff4">The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff></affiliation></author><author><name sortKey="Levin, Adeera" sort="Levin, Adeera" uniqKey="Levin A" first="Adeera" last="Levin">Adeera Levin</name><affiliation><nlm:aff id="aff6">Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;</nlm:aff></affiliation></author><author><name sortKey="Naimark, David M J" sort="Naimark, David M J" uniqKey="Naimark D" first="David M. J." last="Naimark">David M. J. Naimark</name><affiliation><nlm:aff id="aff7">Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;</nlm:aff></affiliation></author><author><name sortKey="Nally, Joseph" sort="Nally, Joseph" uniqKey="Nally J" first="Joseph" last="Nally">Joseph Nally</name><affiliation><nlm:aff id="aff8">Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;</nlm:aff></affiliation></author><author><name sortKey="Rothenbacher, Dietrich" sort="Rothenbacher, Dietrich" uniqKey="Rothenbacher D" first="Dietrich" last="Rothenbacher">Dietrich Rothenbacher</name><affiliation><nlm:aff id="aff9">Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;</nlm:aff></affiliation><affiliation><nlm:aff id="aff10">Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany;</nlm:aff></affiliation></author><author><name sortKey="Stengel, Benedicte" sort="Stengel, Benedicte" uniqKey="Stengel B" first="Benedicte" last="Stengel">Benedicte Stengel</name><affiliation><nlm:aff id="aff11">Institut National de la Santé et de la Recherche Médicale (Inserm) Unité mixte de recherche 1018 - UMR1018) Center for Research in Epidemiology and Population Health, Villejuif, France;</nlm:aff></affiliation><affiliation><nlm:aff id="aff12">UMRS 1018, Paris-Sud University and Versailles Saint Quentin University, Villejuif, France;</nlm:aff></affiliation></author><author><name sortKey="Iseki, Kunitoshi" sort="Iseki, Kunitoshi" uniqKey="Iseki K" first="Kunitoshi" last="Iseki">Kunitoshi Iseki</name><affiliation><nlm:aff wicri:cut="; and" id="aff13">Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan</nlm:aff></affiliation></author><author><name sortKey="Matsushita, Kunihiro" sort="Matsushita, Kunihiro" uniqKey="Matsushita K" first="Kunihiro" last="Matsushita">Kunihiro Matsushita</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation></author><author><name sortKey="Levey, Andrew S" sort="Levey, Andrew S" uniqKey="Levey A" first="Andrew S." last="Levey">Andrew S. Levey</name><affiliation><nlm:aff id="aff14">Division of Nephrology, Tufts Medical Center, Boston, Massachusetts</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26657867</idno><idno type="pmc">4978053</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978053</idno><idno type="RBID">PMC:4978053</idno><idno type="doi">10.1681/ASN.2015060687</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">001905</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001905</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Past Decline Versus Current eGFR and Subsequent ESRD Risk</title><author><name sortKey="Kovesdy, Csaba P" sort="Kovesdy, Csaba P" uniqKey="Kovesdy C" first="Csaba P." last="Kovesdy">Csaba P. Kovesdy</name><affiliation><nlm:aff id="aff1">Department of Medicine, Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee;</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;</nlm:aff></affiliation></author><author><name sortKey="Coresh, Josef" sort="Coresh, Josef" uniqKey="Coresh J" first="Josef" last="Coresh">Josef Coresh</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation></author><author><name sortKey="Ballew, Shoshana H" sort="Ballew, Shoshana H" uniqKey="Ballew S" first="Shoshana H." last="Ballew">Shoshana H. Ballew</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation><affiliation><nlm:aff id="aff4">The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia;</nlm:aff></affiliation></author><author><name sortKey="Levin, Adeera" sort="Levin, Adeera" uniqKey="Levin A" first="Adeera" last="Levin">Adeera Levin</name><affiliation><nlm:aff id="aff6">Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;</nlm:aff></affiliation></author><author><name sortKey="Naimark, David M J" sort="Naimark, David M J" uniqKey="Naimark D" first="David M. J." last="Naimark">David M. J. Naimark</name><affiliation><nlm:aff id="aff7">Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;</nlm:aff></affiliation></author><author><name sortKey="Nally, Joseph" sort="Nally, Joseph" uniqKey="Nally J" first="Joseph" last="Nally">Joseph Nally</name><affiliation><nlm:aff id="aff8">Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;</nlm:aff></affiliation></author><author><name sortKey="Rothenbacher, Dietrich" sort="Rothenbacher, Dietrich" uniqKey="Rothenbacher D" first="Dietrich" last="Rothenbacher">Dietrich Rothenbacher</name><affiliation><nlm:aff id="aff9">Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;</nlm:aff></affiliation><affiliation><nlm:aff id="aff10">Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany;</nlm:aff></affiliation></author><author><name sortKey="Stengel, Benedicte" sort="Stengel, Benedicte" uniqKey="Stengel B" first="Benedicte" last="Stengel">Benedicte Stengel</name><affiliation><nlm:aff id="aff11">Institut National de la Santé et de la Recherche Médicale (Inserm) Unité mixte de recherche 1018 - UMR1018) Center for Research in Epidemiology and Population Health, Villejuif, France;</nlm:aff></affiliation><affiliation><nlm:aff id="aff12">UMRS 1018, Paris-Sud University and Versailles Saint Quentin University, Villejuif, France;</nlm:aff></affiliation></author><author><name sortKey="Iseki, Kunitoshi" sort="Iseki, Kunitoshi" uniqKey="Iseki K" first="Kunitoshi" last="Iseki">Kunitoshi Iseki</name><affiliation><nlm:aff wicri:cut="; and" id="aff13">Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan</nlm:aff></affiliation></author><author><name sortKey="Matsushita, Kunihiro" sort="Matsushita, Kunihiro" uniqKey="Matsushita K" first="Kunihiro" last="Matsushita">Kunihiro Matsushita</name><affiliation><nlm:aff id="aff3">Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</nlm:aff></affiliation></author><author><name sortKey="Levey, Andrew S" sort="Levey, Andrew S" uniqKey="Levey A" first="Andrew S." last="Levey">Andrew S. Levey</name><affiliation><nlm:aff id="aff14">Division of Nephrology, Tufts Medical Center, Boston, Massachusetts</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the American Society of Nephrology : JASN</title><idno type="ISSN">1046-6673</idno><idno type="eISSN">1533-3450</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>eGFR is a robust predictor of ESRD risk. However, the prognostic information gained from the past trajectory (slope) beyond that of the current eGFR is unclear. We examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD. We modeled hazard ratios as a spline function of slopes, adjusting for demographic variables, eGFR, and comorbidities. We used random effects meta–analyses to combine results across studies stratified by cohort type. We calculated the absolute risk of ESRD at 5 years after the last eGFR using the weighted average baseline risk. Overall, 1,080,223 participants experienced 5163 ESRD events during a mean follow-up of 2.0 years. In CKD cohorts, a slope of −6 versus 0 ml/min per 1.73 m<sup>2</sup> per year over the previous 3 years (a decline of 18 ml/min per 1.73 m<sup>2</sup> versus no decline) associated with an adjusted hazard ratio of ESRD of 2.28 (95% confidence interval, 1.88 to 2.76). In contrast, a current eGFR of 30 versus 50 ml/min per 1.73 m<sup>2</sup> (a difference of 20 ml/min per 1.73 m<sup>2</sup>) associated with an adjusted hazard ratio of 19.9 (95% confidence interval, 13.6 to 29.1). Past decline contributed more to the absolute risk of ESRD at lower than higher levels of current eGFR. In conclusion, during a follow-up of 2 years, current eGFR associates more strongly with future ESRD risk than the magnitude of past eGFR decline, but both contribute substantially to the risk of ESRD, especially at eGFR<30 ml/min per 1.73 m<sup>2</sup>.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Am Soc Nephrol</journal-id><journal-id journal-id-type="iso-abbrev">J. Am. Soc. Nephrol</journal-id><journal-id journal-id-type="hwp">jnephrol</journal-id><journal-id journal-id-type="pmc">jnephrol</journal-id><journal-id journal-id-type="publisher-id">ASN</journal-id><journal-title-group><journal-title>Journal of the American Society of Nephrology : JASN</journal-title></journal-title-group><issn pub-type="ppub">1046-6673</issn><issn pub-type="epub">1533-3450</issn><publisher><publisher-name>American Society of Nephrology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26657867</article-id><article-id pub-id-type="pmc">4978053</article-id><article-id pub-id-type="publisher-id">2015060687</article-id><article-id pub-id-type="doi">10.1681/ASN.2015060687</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Epidemiology</subject></subj-group></article-categories><title-group><article-title>Past Decline Versus Current eGFR and Subsequent ESRD Risk</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kovesdy</surname><given-names>Csaba P.</given-names></name><xref ref-type="aff" rid="aff1">*</xref><xref ref-type="aff" rid="aff2"><sup>†</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Coresh</surname><given-names>Josef</given-names></name><xref ref-type="aff" rid="aff3"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ballew</surname><given-names>Shoshana H.</given-names></name><xref ref-type="aff" rid="aff3"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Woodward</surname><given-names>Mark</given-names></name><xref ref-type="aff" rid="aff3"><sup>‡</sup></xref><xref ref-type="aff" rid="aff4"><sup>§</sup></xref><xref ref-type="aff" rid="aff5"><sup>‖</sup></xref></contrib><contrib contrib-type="author"><name><surname>Levin</surname><given-names>Adeera</given-names></name><xref ref-type="aff" rid="aff6"><sup>¶</sup></xref></contrib><contrib contrib-type="author"><name><surname>Naimark</surname><given-names>David M.J.</given-names></name><xref ref-type="aff" rid="aff7">**</xref></contrib><contrib contrib-type="author"><name><surname>Nally</surname><given-names>Joseph</given-names></name><xref ref-type="aff" rid="aff8"><sup>††</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rothenbacher</surname><given-names>Dietrich</given-names></name><xref ref-type="aff" rid="aff9"><sup>‡‡</sup></xref><xref ref-type="aff" rid="aff10"><sup>§§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Stengel</surname><given-names>Benedicte</given-names></name><xref ref-type="aff" rid="aff11"><sup>‖‖</sup></xref><xref ref-type="aff" rid="aff12"><sup>¶¶</sup></xref></contrib><contrib contrib-type="author"><name><surname>Iseki</surname><given-names>Kunitoshi</given-names></name><xref ref-type="aff" rid="aff13">***</xref></contrib><contrib contrib-type="author"><name><surname>Matsushita</surname><given-names>Kunihiro</given-names></name><xref ref-type="aff" rid="aff3"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Levey</surname><given-names>Andrew S.</given-names></name><xref ref-type="aff" rid="aff14"><sup>†††</sup></xref></contrib><on-behalf-of>the CKD Prognosis Consortium</on-behalf-of><aff id="aff1"><label>*</label>Department of Medicine, Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee;</aff><aff id="aff2"><label>†</label>Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee;</aff><aff id="aff3"><label>‡</label>Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;</aff><aff id="aff4"><label>§</label>The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom;</aff><aff id="aff5"><label>‖</label>The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia;</aff><aff id="aff6"><label>¶</label>Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;</aff><aff id="aff7"><label>**</label>Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;</aff><aff id="aff8"><label>††</label>Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio;</aff><aff id="aff9"><label>‡‡</label>Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;</aff><aff id="aff10"><label>§§</label>Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany;</aff><aff id="aff11"><label>‖‖</label>Institut National de la Santé et de la Recherche Médicale (Inserm) Unité mixte de recherche 1018 - UMR1018) Center for Research in Epidemiology and Population Health, Villejuif, France;</aff><aff id="aff12"><label>¶¶</label>UMRS 1018, Paris-Sud University and Versailles Saint Quentin University, Villejuif, France;</aff><aff id="aff13"><label>***</label>Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan; and</aff><aff id="aff14"><label>†††</label>Division of Nephrology, Tufts Medical Center, Boston, Massachusetts</aff></contrib-group><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Dr. Josef Coresh, <addr-line>Chronic Kidney Disease Prognosis Consortium Data Coordinating Center, 2024 East Monument Street, Baltimore, MD 21287</addr-line>. Email: <email>ckdpc@jhmi.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>8</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>11</day><month>12</month><year>2015</year></pub-date><volume>27</volume><issue>8</issue><fpage>2447</fpage><lpage>2455</lpage><history><date date-type="received"><day>23</day><month>6</month><year>2015</year></date><date date-type="accepted"><day>27</day><month>10</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2016 by the American Society of Nephrology</copyright-statement><copyright-year>2016</copyright-year></permissions><self-uri xlink:title="pdf" xlink:href="ASN.2015060687.pdf"></self-uri><abstract><p>eGFR is a robust predictor of ESRD risk. However, the prognostic information gained from the past trajectory (slope) beyond that of the current eGFR is unclear. We examined 22 cohorts to determine the association of past slopes and current eGFR level with subsequent ESRD. We modeled hazard ratios as a spline function of slopes, adjusting for demographic variables, eGFR, and comorbidities. We used random effects meta–analyses to combine results across studies stratified by cohort type. We calculated the absolute risk of ESRD at 5 years after the last eGFR using the weighted average baseline risk. Overall, 1,080,223 participants experienced 5163 ESRD events during a mean follow-up of 2.0 years. In CKD cohorts, a slope of −6 versus 0 ml/min per 1.73 m<sup>2</sup> per year over the previous 3 years (a decline of 18 ml/min per 1.73 m<sup>2</sup> versus no decline) associated with an adjusted hazard ratio of ESRD of 2.28 (95% confidence interval, 1.88 to 2.76). In contrast, a current eGFR of 30 versus 50 ml/min per 1.73 m<sup>2</sup> (a difference of 20 ml/min per 1.73 m<sup>2</sup>) associated with an adjusted hazard ratio of 19.9 (95% confidence interval, 13.6 to 29.1). Past decline contributed more to the absolute risk of ESRD at lower than higher levels of current eGFR. In conclusion, during a follow-up of 2 years, current eGFR associates more strongly with future ESRD risk than the magnitude of past eGFR decline, but both contribute substantially to the risk of ESRD, especially at eGFR<30 ml/min per 1.73 m<sup>2</sup>.</p></abstract><kwd-group><kwd>progression of chronic renal failure</kwd><kwd>glomerular filtration rate</kwd><kwd>epidemiology and outcomes</kwd><kwd>end-stage renal disease</kwd></kwd-group><counts><fig-count count="3"></fig-count><table-count count="2"></table-count><equation-count count="0"></equation-count><ref-count count="34"></ref-count><page-count count="9"></page-count></counts><custom-meta-group><custom-meta><meta-name>cover-date</meta-name><meta-value>August 2016</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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