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
- CKD: Epidemiology, Risk Factors, Prevention - II
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 disease | Prevalence in cohort, N=5,214 | Incidence proportion of ESRD (events/N) | HR (95% CI) per 15 ml/min decrease in eGFR | p-value of interaction | HR (95% CI) per log10 increase in UACR | p-value of interaction |
| Glomerular diseases | 36.5% | 6.5% (124/1,902) | 2.38 (1.89–2.94) | 0.18 | 2.30 (1.78–3.09) | 0.70 |
| Tubulointerstitial diseases | 7.4% | 1.8% (7/386) | 11.36 (2.33–55.55) | 0.17 | 1.93 (0.68–5.47) | 0.61 |
| Vascular diseases | 26.7% | 2.8% (39/1,393) | 6.41 (3.57–11.62) | 0.15 | 1.84 (1.20–2.82) | 0.26 |
| Cystic and congenital diseases | 4.3% | 8.9% (20/224) | 16.13 (6.67–38.46) | 0.004 | 2.07 (0.97–4.43) | 0.62 |
| Other diseases | 5.5% | 2.8% (8/287) | 8.40 (2.70–26.32) | 0.18 | 2.74 (1.09–6.87) | 0.91 |
| Unknown disease | 19.6% | 3.8% (39/1,022) | 3.56 (2.04–6.17) | reference | 2.58 (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