Risk of ESRD and Mortality Associated With Change in Filtration Markers

Overview

Journal Am J Kidney Dis

Specialty Nephrology

Date 2017 Jun 27

PMID 28648303

Citations 10

Authors

Casey M Rebholz

Lesley A Inker

Yuan Chen

Menglu Liang

Meredith C Foster

John H Eckfeldt

Paul L Kimmel

Ramachandran S Vasan

Harold I Feldman

Mark J Sarnak

Chi-Yuan Hsu

Andrew S Levey

Josef Coresh

Affiliations

Soon will be listed here.

Abstract

Background: Using change in estimated glomerular filtration rate (eGFR) based on creatinine concentration as a surrogate outcome in clinical trials of chronic kidney disease has been proposed. Risk for end-stage renal disease (ESRD) and all-cause mortality associated with change in concentrations of other filtration markers has not been studied in chronic kidney disease populations.

Study Design: Observational analysis of 2 clinical trials.

Setting & Participants: Participants in the MDRD (Modification of Diet in Renal Disease; n=317) Study and AASK (African American Study of Kidney Disease and Hypertension; n=373).

Predictors: Creatinine, cystatin C, β-trace protein (BTP), and β-microglobulin (B2M) were measured in serum samples collected at the 12- and 24-month follow-up visits, along with measured GFR (mGFR) at these time points.

Outcomes: ESRD and all-cause mortality.

Measurements: Poisson regression was used to estimate incidence rate ratios and 95% CIs for ESRD and all-cause mortality during long-term follow-up (10-16 years) per 30% decline in mGFR or eGFR for each filtration marker and the average of all 4 markers.

Results: 1-year decline in mGFR, eGFR, eGFR, and the average of the 4 filtration markers was significantly associated with increased risk for incident ESRD in both studies (all P≤0.02). Compared to mGFR, only decline in eGFR was statistically significantly more strongly associated with ESRD risk in both studies (both P≤0.03). Decline in eGFR, but not mGFR or the other filtration markers, was significantly associated with risk for all-cause mortality in AASK only (incidence rate ratio per 30% decline, 4.17; 95% CI, 1.78-9.74; P<0.001), but this association was not significantly different from decline in mGFR (P=0.2).

Limitations: Small sample size.

Conclusions: Declines in mGFR, eGFR, eGFR, and the average of 4 filtration markers (creatinine, cystatin C, BTP, and B2M) were consistently associated with progression to ESRD.

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