Kidney Week

Abstract: FR-PO465

30% GFR Decline in 2 Years Was Observed among 62.5% of CKD Patients Initiated Hemodialysis: A Longitudinal GFR Trajectory Analysis

Session Information

• CKD: Risk Factors for Incidence and Progression - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 301 CKD: Risk Factors for Incidence and Progression

Authors

• Kaihan, Ahmad Baseer, Nagoya University Graduate School of Medicine, Nagoya, Aichi-KEN, Japan

Ahmad Baseer Kaihan,

• Yasuda, Yoshinari, Nagoya University Graduate School of Medicine, Nagoya, Aichi-ken, Japan, Nagoya, Aichi-KEN, Japan

Yoshinari Yasuda,

• Katsuno, Takayuki, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan

Takayuki Katsuno,

• Kato, Sawako, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan

Sawako Kato,

• Imaizumi, Takahiro, Nagoya University Graduate School of Medicine, Nagoya, Aichi-KEN, Japan

Takahiro Imaizumi,

• Ozeki, Takaya, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan., Nagoya, Aichi-KEN, Japan

Takaya Ozeki,

• Hishida, Manabu, Nagoya University Graduate School of Medicine, Nagoya, Aichi-KEN, Japan

Manabu Hishida,

• Tsuboi, Naotake, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan

Naotake Tsuboi,

• Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, AICHI-KEN, Japan

Shoichi Maruyama,

Background

GFR decline rate has been highlighted as a new renal outcome for the clinical trial to reduce the sample size and shorten the observation period. We aimed to evaluate the eGFR trajectory among CKD patients initiated hemodialysis (HD).

Methods

A longitudinal GFR trajectory analysis was conducted among consecutive 112 CKD patients initiated HD between 2014 and 2016 at Nagoya University Hospital. All serum creatinine (SCr) values were collected from the electronic medical record from 2000 to the initiation of HD and eGFR annual decline rate (ADR) was calculated. eGFR ADR stratified into quartile classification and 30%, 40% eGFR decline and doubling of SCr in 2 years were analyzed in association with eGFR ADR.

Results

The causative kidney diseases were 41 (37%) diabetic nephropathy, 37 (33%) nephrosclerosis, 14 (13%) chronic glomerulonephritis, and 20 (18%) others. Median follow-up period was 5.6 years. The proportion of 30%, 40% eGFR decline, and the doubling of SCr in 2 years were shown in Table 1. Kaplan-Meier survival curve analysis for 30% eGFR decline revealed significant difference among quartiles (log-rank p< 0.0001). The associating factors for eGFR ADR were in SCr, eGFR, protein creatinine ratio (PCR), Hb, and SUA univariate, and eGFR (OR 1.14, 95% CI 1.04-1.26, p=0.0008) and PCR ( OR 3.27, 95% CI 1.20-8.92, p= 0.02) in multivariate logistic regression analyses. 30% eGFR decline was observed significantly earlier in the greater amount of PCR quartiles (p<0.001). In GFR categories, G3a showed a tendency to meet 30% eGFR decline later than other GFR categories.

Conclusion

Although 30% GFR decline was the earlier renal outcome in 2 years, approximately 40% of patients initiated HD were negative in this study. The longer observation period should be considered among slowly progressive CKD patients with mild proteinuria and mild-moderately impaired renal function.

30%, 40% eGFR decline and serum creatinine doubling in 2 years among annual GFR decline rate quartiles.

Funding

• Other U.S. Government Support