Abstract: FR-PO388

Time-Centered Approach to Understanding Progression of CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
  • McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Johansen, Kirsten L., University of California San Francisco, San Francisco, California, United States
Background

Traditional approaches to modeling risk of CKD progression do not provide estimates of the time it takes for disease progression to occur by stage of CKD, or the extent to which risk factors may differentially affect the time spent in various CKD stages.

Methods

We used mixed models to estimate person-specific trajectories of renal function among 3682 participants of Chronic Renal Insufficiency Cohort (CRIC), a longitudinal study of persons with CKD. We then used these trajectories to estimate time spent in each CKD stage and compared these times according to combinations of risk factors associated with disease progression.

Results

During 9.5 years of median follow-up, participants spent longer in earlier than later CKD stages, ranging from 9.5 yrs in stage 3 to 0.7 yrs in stage 5 [Figure 1]. Risk factors were associated with larger differences in duration in the earlier vs. later stages of CKD. For example, median duration of CKD was over 8 years shorter in stage 3a, 6 years shorter in stage 3b, but only 5.3 months shorter in stage 5 for those with proteinuria ≥1g/g (vs. <1g/g) [Figure 1]. Participants with controlled diabetes (A1C < 7.5%) and without significant proteinuria spent the longest time in CKD stage 3 [Figure 2a], but spent similar amount of time in stage 5 as participants with uncontrolled diabetes and proteinuria. We also found profound differences in the time spent in CKD stages by presence or absence of proteinuria and uncontrolled systolic BP (≥140 mm Hg) [Figure 2b].

Conclusion

We found marked variations in the time spent in the different stages of CKD based on different risk factors. Time-based metrics of CKD progression may help convey prognostic information to patients and guide clinical decisions, such as timing of access placement and RRT.

Funding

  • Other NIH Support