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Kidney Week

Abstract: PO2336

Estimated GFR Slope and Risk of Subsequent ESKD in Japanese Patients with CKD: The CKD-JAC Study

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Imaizumi, Takahiro, Nagoya University, Nagoya, Aichi, Japan
  • Komaba, Hirotaka, Tokai University, Isehara, Kanagawa, Japan
  • Hamano, Takayuki, Nagoya city University, Nagoya, Aichi, Japan
  • Murotani, Kenta, Kurume University, Kurume, Fukuoka, Japan
  • Hasegawa, Takeshi, Showa University, Tokyo, Japan
  • Fujii, Naohiko, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
  • Nangaku, Masaomi, The University of Tokyo, Tokyo, Japan
  • Fukagawa, Masafumi, Tokai University, Isehara, Kanagawa, Japan
Background

Slope of estimated glomerular filtration rate (eGFR), or rate of eGFR change, is a well-accepted measure of kidney disease progression. Previous studies have shown strong associations between eGFR slope and subsequent ESKD, but there is a dearth of evidence in Asian populations. We aimed to investigate the association between eGFR slope and subsequent ESKD in Japanese patients with CKD using data from the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study.

Methods

We investigated the association of 2-year change in eGFR (slope) with ESKD over the long term. Slopes were estimated with the linear mixed models with an unstructured variance-covariance matrix, random intercept, and random slope for each individual to estimate slope (mixed model slope) or the least-squares linear regression (least-squares slope). We also conducted sensitivity analyses to investigate the association of 1- and 3-year changes in eGFR with ESKD.

Results

Of the total 2966 participants, we included 2381 individuals after excluding those who were censored within the 2-year baseline period (n = 509) and those with eGFR measured less than twice each year (n = 76). The mean slope was -1.70 ± 2.63 ml/min per 1.73 m2 per year when estimated by the mixed-effects model and -1.69 ± 3.18 ml/min per 1.73 m2 per year when estimated by least squares. The restricted cubic splines showed that the association between eGFR slope and ESKD was linear. The adjusted hazard ratio for ESKD associated with a lesser eGFR decline by 1 ml/min/1.73m2 per year was 0.69 (95% CI: 0.66 to 0.73) for the mixed model slopes and 0.74 (95% CI: 0.71 to 0.77) for the least-squares slope. Sensitivity analysis showed that the association between eGFR slope and ESKD was pronounced when the slope was estimated over a longer baseline period.

Conclusion

Our study confirmed a robust and strong association between eGFR slope and subsequent ESKD in Japanese patients with CKD.

Funding

  • Commercial Support