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Abstract: PO2419

Association Between Estimated Glomerular Filtration Rate Decline and Clinical Outcomes in Nondiabetic CKD

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Wanner, Christoph, Universitatsklinikum Wurzburg Medizinische Klinik und Poliklinik I, Wurzburg, Bayern, Germany
  • Schuchhardt, Johannes, MicroDiscovery GmbH, Berlin, Germany
  • Bauer, Chris, MicroDiscovery GmbH, Berlin, Germany
  • Brinker, Meike Daniela, Bayer AG, Berlin, Germany
  • Kleinjung, Frank, Bayer AG, Berlin, Germany
  • Vaitsiakhovich, Tatsiana, Bayer AG, Berlin, Germany
Background

There is limited evidence on association between surrogate laboratory endpoints and hard clinical outcomes in chronic kidney disease (CKD). This real-world data analysis investigated dependence between relative estimated glomerular filtration rate (eGFR) decline of ≥30%, 40%, 57% and cardio-renal outcomes in non-diabetic CKD patients treated in routine clinical practice.

Methods

Individual-level data from the US claims database, Optum Clinformatics Data Mart (CDM), for years 2008 – 2018 were analysed. Adult individuals were required to have CKD stage 3 or 4 (index date), 365 days of continuous insurance prior to index (baseline period). Individuals with diabetes mellitus, CKD stage 5 or end-stage kidney disease (ESKD) prior index or kidney failure, transplant or dialysis in the baseline period were excluded. Patients were followed until insurance/data end, or death. Two selected hard clinical outcomes were hospitalisation for heart failure (HHF) and a composite of ESKD/kidney failure/need for dialysis. To investigate the association between eGFR decrease and clinical outcomes, an intercurrent event analysis was performed using eGFR decline of ≥30%, ≥40% or ≥57% as an intercurrent event.

Results

Of 64 million individuals in Optum CDM, 504,924 satisfied the selection criteria, median age 75 years, 60% female, 10% black. At baseline, eGFR values were available for 62% of individuals; median eGFR was 53; 94% of those patients had at least one eGFR value in the follow-up period of a median 744 days. Proportion of the patients with eGFR decline of ≥30%, 40%, 57% was 5%, 3% and 1%. More rapid eGFR decline was associated with increased risk of the outcome. The hazard ratio for HHF was 3.03, 3.41, 3.86 and for ESKD/kidney failure/need for dialysis it was 5.61, 8.29 and 18.63 in patients with eGFR decline of ≥30%, 40%, 57% as compared to those with no such decline, respectively.

Conclusion

In this analysis of the US non-diabetic CKD patients treated in routine clinical practice, a relative eGFR decline of ≥30%, ≥40%, ≥57% was associated with a subsequent HHF and ESKD/kidney failure/need for dialysis, supporting that carefully selected lab-based surrogate measures may be used as early indicators of hard clinical outcomes.

Funding

  • Commercial Support