Abstract: FR-PO419

Change in Creatinine-Based Estimated GFR versus Cystatin-C-Based Estimated GFR and Renal Outcome in Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Kim, Su Hyun, Samsung medical center Sungkyunkwan University School of medicine, Seoul, Korea (the Republic of)
  • Jeon, Junseok, Samsung medical center, Seoul, Korea (the Republic of)
  • Kim, Minjung, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Jang, Hye Ryoun, None, Seoul, Korea (the Republic of)
  • Kim, Yoon-Goo, Samsung Medical Center , Seoul, Korea (the Republic of)
  • Kim, Dae Joong, Samsung medical center Sungkyunkwan University School of medicine, Seoul, Korea (the Republic of)
  • Oh, Ha Young, Samsung medical center Sungkyunkwan University School of medicine, Seoul, Korea (the Republic of)
  • Huh, Wooseong, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
Background

Many studies have demonstrated that an early change in estimated glomerular filtration rate (eGFR) predicts the risk of chronic kidney disease (CKD) progression. However, there are few studies comparing prognostic power between creatinine-based eGFR slope (eGFRcre slope) and cystatin-C-based eGFR slope (eGFRcys slope). This study examined which eGFR slope during first-year was superior in identification of high-risk group of progression to end-stage renal disease (ESRD) in patient with CKD.

Methods

From October 2010 to November 2016, patients who had simultaneous measurements of serum creatinine and cystatin-C more than 3 times for 1 year were identified. We calculated baseline eGFR values and first-year eGFR slopes using CKD-EPI equation and linear regression analyses. The patients with baseline eGFR ≥ 60 ml/min/1.73m2 were excluded. We defined a rapid progression as eGFR slope < -5 mL/min/1.73m2/year. We assessed association between first-year eGFR slopes and progression to ESRD (defined as initiation of dialysis or kidney transplantation) by cox proportional hazard model.

Results

Total 857 patients were included. Forty% of subjects had diabetes. Baseline eGFRcre were 36.7 (25.8 – 47.2) ml/min/1.73m2 and eGFRcys were 36.5 (25.3 – 49.1) ml/min/1.73m2. During follow-up of 2.4 (1.3 – 3.3) years, 78 (9.1%) events occurred. Both eGFRcre slope and eGFRcys slope were associated with higher risk of ESRD independently of baseline eGFR (HR = 0.95 [0.93 – 0.97], HR = 0.96 [0.95 – 0.98], respectively). Both creatinine and cystatin-C based-rapid progression were associated with increased risk of ESRD (HR = 2.25 [1.44 – 3.52], HR = 1.77 [1.10 – 2.86], respectively).
In subgroup analyses of rapid progression group by creatinine (N = 295), eGFRcys slope was not associated with risk of ESRD (HR = 0.99 [0.96 – 1.03], P = 0.68). Whereas, eGFRcre slopes contributed to further discrimination of higher risk of ESRD in subjects with rapid progression by cystatin-C (HR = 0.96 [0.93 – 0.98], P = 0.002).

Conclusion

These findings suggest that eGFRcre slope may be superior to eGFRcys in identification of high-risk group in patient with CKD.