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Kidney Week

Abstract: PO0538

Association of eGFR Index Category and Annual Slope with Adverse Clinical Outcomes in Japan

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Zhang, Ling, Boehringer Ingelheim USA, Ridgefiled, Connecticut, United States
  • Kyaw, Moe H., Boehringer Ingelheim USA, Ridgefiled, Connecticut, United States
  • Ono, Yasuhisa, NIppon Boehringer Ingelheim, Tokyo, Japan
  • Hauske, Sibylle Jenny, Boehringer Ingelheim Germany, Ingelheim, Germany
Background

The relationship between the slope of eGFR with adverse clinical events has not been evaluated extensively. The objective of the study was to assess the association between eGFR and clinical outcomes.

Methods

The study population included persons with 3 or more eGFR values in the MDV database between January 1, 2014 and September 31, 2019. Patients were stratified into 5 index eGFR categories (TABLE). Least square regression model was used to examine the association between eGFR and its slope vs. study outcomes. Patients were stratified into 5 index eGFR categories (TABLE). Least square regression model was used to calculate the annual rate of eGFR change to stratify into 6 categories. Cox proportional hazard model was applied to examine the association between eGFR and its slope vs. study outcomes.

Results

57,692 patients met the study criteria, and were grouped by index eGFR and its slope (TABLE). The mean age ranged from 56.69 to 74.21 in the index eGFR and from 65.3 to 67.2 in the slope categories. The risk of all-cause mortality or hospitalization, CV death, and any CV or renal outcomes were higher among the low and high index eGFR compared to the reference groups (grade 3 eGFR and -1~+1 slope), as well as those with rrapidly declining or increasing eGFR.

Conclusion

Our study showed that those with the highest or lowest categories in index eGFR and eGFR slope had a higher risk for adverse clinical outcomes. Further studies are needed to confirm the findings and explore potential reasons why high eGFR and rapid increase are associated with mortality, CV and renal events.

Hazard Ratio of clinical events with eGFR and slope categories
Hazard Ratio (95% CI)
eGFR category with number (percentage)All cause deathCardiovascular DeathAny HospitalizationCV Events**Renal Events***
Index eGFR category (ml/min/1.73m2)* n=57,692
G5:eGFR<15
N=552 (0.09%)
4.28 (2.87-6.4)4.46 (2.7-7.34)3.36 (2.83-4)3.46 (2.8-4.26)4.61 (1.86-11.4)
G4: eGFR:15-29
N=1,279 (2.21%)
2.88 (2.12-3.92)2.95 (2.01-4.32)1.89 (1.66-2.16)1.77 (1.5-2.08)2.01 (0.98-4.12)
G3: eGFR:30-59
N=14,442 (25.03%)
1.26 (1.08-1.47)1.27 (1.04-1.56)1.24 (1.17-1.32)1.17 (1.08-1.27)0.693 (0.445-1.08)
G2: eGFR:60-89 N=31,012 (53.75%) (reference)11111
G1: eGFR5:>90
N= 10,407 (18.03%)
1.47 (1.23-1.77)1.46 (1.14-1.86)1.17 (1.09-1.25)1.29 (1.17-1.43)5.07 (2.74-9.38)
Annual eGFR slope (ml/min/1.73m2/year) n=57,692
<-5 N= 11083 (19.21%)1.52 (1.33-1.74)1.49 (1.26-1.77)1.2 (1.14-1.26)1.24 (1.16-1.32)1.86 (1.43-2.42)
-3,-5 N= 6610 (11.45%)1.15 (0.978-1.36)1.1 (0.888-1.35)1.04 (0.976-1.1)1.08 (1-1.17)1.62 (1.2-2.17)
-1,-3 N= 10612 (18.39%)1.09 (0.939-1.27)1.12 (0.928-1.35)0.983 (0.932-1.04)1.02 (0.954-1.09)1.57 (1.2-2.07)
-1,+1 N=12028 (20.85%)
(reference group)
11111
+1,+3 N=7389 (12.81%)1.06 (0.897-1.25)1.1 (0.893-1.36)0.994 (0.937-1.05)1.03 (0.95-1.11)1.74 (1.2-2.5)
>=+3 N=9970 (17.28%)1.77 (1.54-2.04)1.84 (1.54-2.2)1.24 (1.18-1.31)1.29 (1.2-1.38)2.56 (1.74-3.77)

* eGFR = 194 x Cr-1.094x Age-0.287 **stroke, CHF, MI, ***ESRD, dialysis, acute kidney failure, renal transplant.

Funding

  • Private Foundation Support