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Abstract: PO2344

Predicting ESKD Risk and Time to RRT Initiation Based on Past Slope and Current Value of eGFR: The CKD-JAC Study

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Komaba, Hirotaka, Tokai Daigaku, Isehara, Kanagawa, Japan
  • Imaizumi, Takahiro, Nagoya Daigaku, Nagoya, Japan
  • Hamano, Takayuki, Nagoya Shiritsu Daigaku, Nagoya, Japan
  • Murotani, Kenta, Kurume Daigaku, Kurume, Japan
  • Hasegawa, Takeshi, Showa Daigaku, Tokyo, Japan
  • Fujii, Naohiko, Hyogo Kenritsu Nishinomiya Byoin, Nishinomiya, Japan
  • Fukagawa, Masafumi, Tokai Daigaku, Isehara, Kanagawa, Japan
Background

Past slope and current estimated glomerular filtration rate (eGFR) are used to predict future risk of end-stage kidney disease (ESKD) and time to renal replacement therapy (RRT) initiation in clinical practice, but there is limited quantitative evidence supporting this practice. To address this, we analyzed data from the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study.

Methods

We investigated the association of 2-year eGFR slope, estimated using linear mixed models, with subsequent risk of ESKD using Cox regression models, adjusting for eGFR and other potential confounders collected 2 years after cohort entry. We calculated the net reclassification improvement (NRI) to assess whether adding past slope to age, sex, eGFR, and urine albumin-to-creatinine ratio (UACR) improves ESKD risk prediction. We predicted time to RRT initiation based on the past slope and current eGFR, assuming eGFR of 6 mL/min/1.73m2 to be the timing of RRT initiation, and compared it with actual time to RRT initiation.

Results

We included 2381 participants who had survived free of ESKD for 2 years and with eGFR measurements at least twice each year. The mean 2-year eGFR slope was -1.70 ± 2.63 mL/min per 1.73 m2 per year. During a median follow-up of 4.7 years after the 2-year slope evaluation period, 175 participants died and 810 reached ESKD requiring RRT. In adjusted analysis, lesser slope of eGFR decline was associated with lower risk of ESKD (hazard ratio per 1 mL/min per 1.73 m2 per year, 0.89; 95% CI, 0.87 to 0.92). Adding past eGFR slope to age, sex, eGFR, and UACR substantially improved classification accuracy in 2-year risk prediction of ESKD, with an NRI of 0.343 (95% CI, 0.036 to 0.662). Among 560 individuals who were predicted to initiate RRT during the study period and actually reached ESKD, the median predicted time to RRT was 30.6 months (IQR, 13.0 to 55.7), the median actual time to RRT was 25.5 months (IQR, 12.3 to 47.0), and the median of these differences was -1.5 months (IQR, -14.3 to 7.3). The prediction became more accurate as RRT initiation was predicted to occur in the closer future.

Conclusion

Our results indicate that past eGFR slope adds information to ESKD risk assessment beyond current eGFR and that combination of these informs prediction of time to RRT initiation.

Funding

  • Commercial Support