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Kidney Week

Abstract: FR-PO286

Increasing and Declining Estimated Glomerular Filtration Rates Predict Mortality Among a Community-Based Cohort

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Sato, Yuji, University of Miyazaki Hospital, Miyazaki, Japan
  • Fujimoto, Shouichi, University of Miyazaki, Miyazaki, Japan
  • Iseki, Kunitoshi, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Konta, Tsuneo, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Moriyama, Toshiki, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Yamagata, Kunihiro, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Tsuruya, Kazuhiko, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Narita, Ichiei, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Kondo, Masahide, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Kasahara, Masato, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Shibagaki, Yugo, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Asahi, Koichi, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
  • Watanabe, Tsuyoshi, Steering Committee for ‘‘Examination of the Positioning of CKD in Specific Health Check and Guidance,’’, Fukushima, Japan
Background

Serum creatinine based glomerular filtration rate (eGFR) is widely used to estimate the true glomerular filtration rate (eGFR) and as a tool for predicting risks of end-stage kidney disease (ESKD) and/or death in the field of public health. Most studies have focused on populations with a declining eGFR.

Methods

We enrolled a Japanese community-based cohort (N = 321,028; age 63.0 ± 7.8 years; men, 41.2%) via the public health check-up system. The follow-up period was 1,566 ± 501 days. The participants were classified into 12 annual eGFR change rate groups. Cox regression analyses were performed to calculate risks for all-cause mortality as the primary outcome measure. Stratified analyses were also conducted according to the level of dipstick proteinuria, annual body weight (BW) change of <0% and ≥0%, baseline eGFR ≥60 mL/min/1.73 m2 and 15−59 mL/min/1.73 m2, age ≤64 years old and >65 years old, sex, and the presence or absence of diabetes.

Results

There were 13.8% participants with an eGFR of 15−59 mL/min/1.73 m2, and 8.9% reported a history of cardiovascular disease (CVD) Thus, our cohort was not at a high risk of both ESKD and CVD. During the study period, 2,604 (0.81%) died. Multivariable Cox regression analysis showed that increasing, as well as declining, eGFR was significantly associated with mortality when an annual eGFR change rate of 0%–4.9% was set as the reference range (U-shaped pattern). For example, the adjusted hazard ratio and 95% confidence interval of an annual eGFR change rate of ≥25% and ≤−25% was 14.17 (10.40–19.31) and 13.84 (9.69–19.76), respectively. Stratified analyses revealed that every stratification still demonstrated a significant U-shaped relationship, even though participants were grouped by dipstick proteinuria level, annual BW change, age, eGFR level, age, sex, and diabetes.

Conclusion

Increasing as well as declining eGFR is an important factor in patient mortality. Proteinuria, BW change, baseline eGFR level, age, sex, and diabetes did not affect this relationship.