Abstract: FR-PO489

Greater Variability in Kidney Function Is Associated with an Increased Risk of ESRD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Yan, Yan, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States
  • Bowe, Benjamin Charles, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States
  • Xie, Yan, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States
  • Li, Tingting, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States
  • Palant, Carlos E., Research and Medical Service, Veterans Affairs Medical Center, Washington, District of Columbia, United States
  • Al-Aly, Ziyad, Clinical Epidemiology Center, Research and Development Service, Veterans Affairs St Louis Health Care System, St. Louis, Missouri, United States
Background

Intra-individual variability in kidney function is an independent predictor of all-cause mortality, providing additional prognostic information beyond baseline kidney function and prior slope; however, its prognostic significance for ESRD is not known.

Methods

To examine this question we assembled a cohort of 1,004,741 United States veterans with an eGFR above 60 ml/min/1.73m3 between October 2001-2002, where date of last measurement in this period was assigned T0, and used adjusted Cox Proportional Hazard models to examine the association between eGFR variability and risk of ESRD. Variability in kidney function was defined for each participant as the coefficient of variation of the regression line modeled on all outpatient eGFR measures during the three years before T0.

Results

After a median follow-up of 13.08 years, there were 2.76, 3.41, 4.01, and 5.57% cases of ESRD in the lowest to highest quartiles of eGFR variability, respectively. Compared with the referent category (lowest quartile), participants had a graded increase in risk of ESRD with a hazard ratio of 1.10 (95%CI: 1.06-1.13), 1.24 (1.20-1.28), and 1.73 (1.68-1.79) in quartiles 2, 3, and 4, respectively. Results were consistent across numerous sensitivity analyses.

Conclusion

Our results demonstrate that higher eGFR variability was associated with increased risk of ESRD.

Funding

  • Veterans Affairs Support