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Abstract: FR-PO1022

Association Between eGFR Variability and Risk of Cardiovascular Events and Mortality: The SPRINT Trial

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Malhotra, Rakesh, University of California San Diego, San Diego, California, United States
  • Katz, Ronit, University of Washington, Seattle, Washington, United States
  • Jotwani, Vasantha, UCSF, San Francisco, California, United States
  • Agarwal, Adhish, University of Utah, Salt Lake City, Utah, United States
  • Cohen, Debbie L., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
  • Cushman, William C., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Killeen, Anthony Alexander, University of Minnesota, Minneapolis, Minnesota, United States
  • Papademetriou, Vasilios, Georgetown University, Potomac, Maryland, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
  • Raphael, Kalani L., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
  • Rocco, Michael V., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Tamariz, Leonardo, University of Miami, Doral, Florida, United States
  • Wright, Jackson T., Case Western Research University, Cleveland, Ohio, United States
  • Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States
  • Ix, Joachim H., UCSD, San Diego, California, United States
Background

In clinical practice, there is considerable visit-to-visit variability in estimated glomerular filtration rate (eGFR). While low eGFR is an established cardiovascular disease (CVD) risk factor, less is known about the clinical significance of eGFR variability over time.

Methods

Among 7520 SPRINT participants, we used proportional hazards models to estimate associations between eGFR variability (measured by coefficient of variation, CV) and subsequent CVD events and all-cause mortality. The CV (SD/mean) was calculated from eGFR values measured at 6-, 12-, and 18-month study visits. CVD events were defined as the composite of MI, ACS, stroke, heart failure, or CVD death. The final model was adjusted for demographics, randomization, prior CVD, heart failure, current smoking, body mass index, serum lipids, baseline systolic BP, albuminuria, eGFR at month 6, medications (ACEI/ARB or diuretics at month 6) and fasting status.

Results

The mean age was 68±9 years, 65% were men, and 58% were white. The mean eGFR was 73±21 ml/min/1.73m2 at 6 months. There were 370 CVD events and 154 deaths during a median follow-up of 2.4 years. In adjusted model, greater eGFR variability was associated with all-cause mortality (hazard ratio (HR) per SD increase in eGFR-CV (0.06), 1.28; 95% CI 1.14 - 1.44). Associations were somewhat weaker for CVD events (HR 1.06; 0.96 -1.17) (Figure 1). When variability was evaluated by quartiles, the highest compared with the lowest quartile was associated with both all-cause mortality (HR 1.57; 0.99 - 2.47) and CVD events (HR 1.35; 0.99 - 1.84). Associations were similar when stratified by treatment arm and baseline CKD status.

Conclusion

Greater eGFR variability was associated with higher risk for all-cause mortality in SPRINT trial participants, independent of baseline eGFR. Future studies should evaluate mechanisms underlying these associations.

Funding

  • NIDDK Support