Kidney Week

Abstract: FR-PO324

Association of eGFR Slopes Before and After CKD Education with Renal Prognosis

Session Information

• CKD: Clinical, Outcomes, Trials - II
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Uemura, Takayuki, Nara Prefecture General Medical Center, Nara, Nara, Japan

Takayuki Uemura,

• Matsui, Masaru, Nara Prefecture General Medical Center, Nara, Nara, Japan

Masaru Matsui,

• Kokubu, Maiko, Nara Prefecture General Medical Center, Nara, Nara, Japan

Maiko Kokubu,

• Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan

Kazuhiko Tsuruya,

Background

Multidisciplinary education for patients with CKD plays a critical role in the prevention for CKD progression and development of ESRD. In this study, we thus aimed to determine the relationship between eGFR slopes before and after CKD education and renal prognosis.

Methods

This is a retrospective cohort study on 617 patients who underwent in-hospital CKD education in Nara Prefecture General Medical Center between Jan. 2013 and Dec. 2016. Baseline data were collected at the time of CKD education. Patients with acute kidney injury, urologic malignancies, or collagen disease were excluded, leaving 194 patients for analysis. We calculated two eGFR slopes before and after education with three eGFR levels which were measured at 3 months to 1 year before CKD education, baseline and at least 1 year after education. We divided into 4 slope categories according to median levels of two eGFR slopes before and after education: slope categories were defined as slow-slow, fast-slow, slow-fast, fast-fast eGFR decliner. Outcomes are ESRD and eGFR decline of > 30%. Kaplan-Meier curve and Cox proportional hazards model with propensity adjustment were used to assess the association between slope categories and incidence of renal events. Patients with fast-slow eGFR decline were used as a reference group.

Results

The median age of study participants was 68 (59-78) years and 130 (67%) were male. The median levels of baseline eGFR were 33 (21-48) mL/min/1.73m². During the median follow-up period of 35 months, renal events occurred in 53 participants. Crude Kaplan-Meier analysis showed patients with slow-fast and fast-fast eGFR declines were significantly associated with renal events compared with those with slow-slow and fast-slow eGFR declines (p<0.001). In adjusted Cox hazard analysis, hazard ratios for outcomes were 1.72 (95%CI 0.38-8.8) for slow-slow, 5.15 (95%CI 1.72-22.2) for slow-fast and 7.27 (95%CI 2.53-30.7) for fast-fast eGFR decliner. Additionally, c-statistics of eGFR slope before education for renal events was 0.596 but that of eGFR slope after education was 0.843 and the cut-off level was -2.5 mL/min/1.73m²/year.

Conclusion

Improvement from fast to slow eGFR decline via CKD education was significantly associated with better renal prognosis. However, CKD patients with rapid eGFR decline of ≤-2.5 mL/min/1.73m² after education have poor renal outcomes.