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Kidney Week

Abstract: FR-PO184

The Impact of Kidney Disease Etiology on the Association Between eGFR and Albuminuria with ESRD and All-Cause Mortality in the GCKD Cohort

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Scheppach, Johannes B., Johns Hopkins University, Baltimore, Maryland, United States
  • Coresh, Josef, Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland, United States
  • Schneider, Markus P., University of Erlangen-Nuremberg, Erlangen, Germany
  • Kottgen, Anna, Medical Center - University of Freiburg, Freiburg, Germany
  • Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States
  • Eckardt, Kai-Uwe, University Medicine-Charite, Berlin, Germany

Group or Team Name

  • GCKD Study Investigators
Background

Chronic kidney disease (CKD) is classified according to cause of kidney disease, estimated glomerular filtration rate (eGFR) and albuminuria, but risk prediction mainly relies on eGFR and albuminuria. We investigated the impact of kidney disease etiology on the association of kidney disease measures with adverse outcomes.

Methods

We studied 5,214 patients with CKD in the German Chronic Kidney Disease (GCKD) study, where the treating nephrologists assessed the cause of kidney disease. We grouped causes according to the KDIGO guideline with sensitivity analyses for alternative classifications. We analyzed the relative hazard of end-stage renal disease (ESRD) and all-cause mortality as a function of eGFR and urinary albumin-creatinine-ratio (UACR) using age, sex, German origin, systolic blood pressure, smoking, diabetes, BMI and history of cardiovascular disease as covariates. We tested for interaction between eGFR and UACR with cause of kidney disease in a Cox proportional hazards model.

Results

We observed 237 ESRD events and 418 deaths over 4.5 years of follow-up. Risk of ESRD and mortality increased with lower eGFR and higher UACR in each of the CKD causes where sample size was adequate. In the ESRD model, interaction of CKD cause was only present for eGFR with cystic or congenital diseases (p=0.004, see Table), although power to detect modest interactions is limited. For all-cause mortality, no significant interaction was observed between CKD cause and eGFR or UACR.

Conclusion

KDIGO staging of ESRD and mortality risk by eGFR and albuminuria is valid across different causes of CKD, although the eGFR relationship to ESRD risk is stronger in cystic or congenital kidney disease.

Cause of kidney diseasePrevalence in cohort,
N=5,214
Incidence proportion of ESRD (events/N)HR (95% CI)
per 15 ml/min decrease in eGFR
p-value of interactionHR (95% CI)
per log10 increase in UACR
p-value of interaction
Glomerular diseases36.5%6.5%
(124/1,902)
2.38
(1.89–2.94)
0.182.30
(1.78–3.09)
0.70
Tubulointerstitial diseases7.4%1.8%
(7/386)
11.36
(2.33–55.55)
0.171.93
(0.68–5.47)
0.61
Vascular diseases26.7%2.8%
(39/1,393)
6.41
(3.57–11.62)
0.151.84
(1.20–2.82)
0.26
Cystic and congenital diseases4.3%8.9%
(20/224)
16.13
(6.67–38.46)
0.0042.07
(0.97–4.43)
0.62
Other diseases5.5%2.8%
(8/287)
8.40
(2.70–26.32)
0.182.74
(1.09–6.87)
0.91
Unknown disease19.6%3.8%
(39/1,022)
3.56
(2.04–6.17)
reference2.58
(1.70–3.92)
reference

Prevalence of CKD causes, incidence and HRs for ESRD associated with lower eGFR or higher UACR and p-values of the interaction between cause and eGFR/UACR, adjusted for age, sex, German origin, systolic blood pressure, smoking, diabetes, BMI, CVD history

Funding

  • Private Foundation Support