Abstract: PO0538
Association of eGFR Index Category and Annual Slope with Adverse Clinical Outcomes in Japan
Session Information
- CKD Clinical, Outcomes, and Trials - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
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 death | Cardiovascular Death | Any Hospitalization | CV 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) | 1 | 1 | 1 | 1 | 1 |
| 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) | 1 | 1 | 1 | 1 | 1 |
| +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