Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality
Identifieur interne : 001F40 ( Pmc/Corpus ); précédent : 001F39; suivant : 001F41Decline 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.
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
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PMC:4172342Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality</title><author><name sortKey="Coresh, Josef" sort="Coresh, Josef" uniqKey="Coresh J" first="Josef" last="Coresh">Josef Coresh</name></author><author><name sortKey="Turin, Tanvir Chowdhury" sort="Turin, Tanvir Chowdhury" uniqKey="Turin T" first="Tanvir Chowdhury" last="Turin">Tanvir Chowdhury Turin</name></author><author><name sortKey="Matsushita, Kunihiro" sort="Matsushita, Kunihiro" uniqKey="Matsushita K" first="Kunihiro" last="Matsushita">Kunihiro Matsushita</name></author><author><name sortKey="Sang, Yingying" sort="Sang, Yingying" uniqKey="Sang Y" first="Yingying" last="Sang">Yingying Sang</name></author><author><name sortKey="Ballew, Shoshana H" sort="Ballew, Shoshana H" uniqKey="Ballew S" first="Shoshana H" last="Ballew">Shoshana H. 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></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24892770</idno><idno type="pmc">4172342</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172342</idno><idno type="RBID">PMC:4172342</idno><idno type="doi">10.1001/jama.2014.6634</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001F40</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001F40</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality</title><author><name sortKey="Coresh, Josef" sort="Coresh, Josef" uniqKey="Coresh J" first="Josef" last="Coresh">Josef Coresh</name></author><author><name sortKey="Turin, Tanvir Chowdhury" sort="Turin, Tanvir Chowdhury" uniqKey="Turin T" first="Tanvir Chowdhury" last="Turin">Tanvir Chowdhury Turin</name></author><author><name sortKey="Matsushita, Kunihiro" sort="Matsushita, Kunihiro" uniqKey="Matsushita K" first="Kunihiro" last="Matsushita">Kunihiro Matsushita</name></author><author><name sortKey="Sang, Yingying" sort="Sang, Yingying" uniqKey="Sang Y" first="Yingying" last="Sang">Yingying Sang</name></author><author><name sortKey="Ballew, Shoshana H" sort="Ballew, Shoshana H" uniqKey="Ballew S" first="Shoshana H" last="Ballew">Shoshana H. 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></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><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>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">7501160</journal-id><journal-id journal-id-type="pubmed-jr-id">5346</journal-id><journal-id journal-id-type="nlm-ta">JAMA</journal-id><journal-id journal-id-type="iso-abbrev">JAMA</journal-id><journal-title-group><journal-title>JAMA</journal-title></journal-title-group><issn pub-type="ppub">0098-7484</issn><issn pub-type="epub">1538-3598</issn></journal-meta><article-meta><article-id pub-id-type="pmid">24892770</article-id><article-id pub-id-type="pmc">4172342</article-id><article-id pub-id-type="doi">10.1001/jama.2014.6634</article-id><article-id pub-id-type="manuscript">NIHMS608574</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality</article-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Coresh</surname><given-names>Josef</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Turin</surname><given-names>Tanvir Chowdhury</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Matsushita</surname><given-names>Kunihiro</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Sang</surname><given-names>Yingying</given-names></name><degrees>MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Ballew</surname><given-names>Shoshana H</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Appel</surname><given-names>Lawrence J.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Arima</surname><given-names>Hisatomi</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Chadban</surname><given-names>Steven J.</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Cirillo</surname><given-names>Massimo</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Djurdjev</surname><given-names>Ognjenka</given-names></name><degrees>MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Green</surname><given-names>Jamie A</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Heine</surname><given-names>Gunnar H</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Inker</surname><given-names>Lesley A</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Irie</surname><given-names>Fujiko</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Ishani</surname><given-names>Areef</given-names></name><degrees>MD, MS</degrees></contrib><contrib contrib-type="author"><name><surname>Ix</surname><given-names>Joachim H.</given-names></name><degrees>MD, MAS</degrees></contrib><contrib contrib-type="author"><name><surname>Kovesdy</surname><given-names>Csaba P.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Marks</surname><given-names>Angharad</given-names></name><degrees>MBBCh</degrees></contrib><contrib contrib-type="author"><name><surname>Ohkubo</surname><given-names>Takayoshi</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Shalev</surname><given-names>Varda</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Shankar</surname><given-names>Anoop</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Wen</surname><given-names>Chi Pang</given-names></name><degrees>MD, DrPH</degrees></contrib><contrib contrib-type="author"><name><surname>de Jong</surname><given-names>Paul E.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Iseki</surname><given-names>Kunitoshi</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Stengel</surname><given-names>Benedicte</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Gansevoort</surname><given-names>Ron T.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Levey</surname><given-names>Andrew S</given-names></name><degrees>MD</degrees></contrib><on-behalf-of>for the CKD Prognosis Consortium</on-behalf-of></contrib-group><aff id="A1"> Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA (J Coresh, K Matsushita, Y Sang, SH Ballew); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (TC Turin); Johns Hopkins Medical Institutions, Baltimore, MD, 21205 (LJ Appel); The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia (H Arima); Department of Nephrology and Transplantation, Royal Prince Alfred Hospital, Sydney, NSW, Australia and Sydney Medical School, University of Sydney, Sydney, NSW, Australia (SJ Chadban); Department of Medicine, University of Salerno, Salerno, Italy (M Cirillo); BC Provincial Renal Agency, Vancouver, Canada (O Djurdjev); Nephrology Department, Geisinger Medical Center, Danville, PA, USA (JA Green); Department of Internal Medicine IV—Nephrology and Hypertension, Saarland University Medical Center, D-66421 Homburg, Germany (GH Heine); Division of Nephrology at Tufts Medical Center, Boston, MA 02111, USA (LA Inker, AS Levey); Department of Health and Welfare, Ibaraki Prefectural Office, Mito, Japan (F Irie); Minneapolis VA Health Care System and Department of Medicine, University of Minnesota, Minneapolis, MN, USA (A Ishani); University of California San Diego, San Diego, CA, USA (JH Ix); Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, TN, USA (CP Kovesdy); Division of Applied Health Sciences, University of Aberdeen, and NHS Grampian, Foresterhill, Aberdeen, UK (A Marks); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan, Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan, and Department of Health Science, Shiga University of Medical Science, Setatuskinowa, Otsu, Japan (T Ohkubo); Medical Informatics Department, Maccabi Healthcare Services, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (V Shalev); Department of Family Medicine and Population Health, Virginia Commonwealth University, School of Medicine, 830 E. Main Street, P.O. Box 980212, Richmond, VA 23298-0212 (A Shankar); China Medical University Hospital, Taichung, Taiwan and Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan (CP Wen); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands (PE de Jong, RT Gansevoort); Dialysis Unit, University Hospital of The Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan (K Iseki); Inserm U1018, CESP Center for Research in Epidemiology and Population Health, Villejuif, France and UMRS 1018, Paris-Sud University, Villejuif, France (B Stengel)</aff><author-notes><corresp id="CR1">Address for Correspondence: Chronic Kidney Disease Prognosis Consortium Data Coordinating Center (Principal Investigator, Josef Coresh, MD, PhD), 615 N. Wolfe Street, Baltimore, MD 21205; Tel: 410-955-9917, Fax: 410-955-8086, <email>ckdpc@jhmi.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>26</day><month>6</month><year>2014</year></pub-date><pub-date pub-type="ppub"><day>25</day><month>6</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>25</day><month>6</month><year>2015</year></pub-date><volume>311</volume><issue>24</issue><fpage>2518</fpage><lpage>2531</lpage><pmc-comment>elocation-id from pubmed: 10.1001/jama.2014.6634</pmc-comment>
<abstract><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></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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