Abstract: FR-PO948
Greater Variability in eGFR Is Associated with CKD Progression: A Retrospective Japanese Nationwide Database Study
Session Information
- CKD Epidemiology, Risk Factors, Prevention - II
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Onishi, Yasuhiro, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
- Nagasu, Hajime, Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan
- Tsuji, Kenji, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
- Tanabe, Katsuyuki, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
- Morinaga, Hiroshi, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
- Uchida, Haruhito A., Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
- Yano, Yuichiro, NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
- Kashihara, Naoki, Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan
- Wada, Jun, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
Background
Variability in renal function is a phenomenon frequently observed in routine clinical practice. This variability may be indicative of pathophysiological factors, including the impaired autoregulation of renal blood flow and the effective circulating volume. With this study, our aim was to assess the relationship between the variability in eGFR and the risk of CKD progression.
Methods
We utilized the Japanese Chronic Kidney Disease Database (J-CKD-DB-Ex), a comprehensive, nationwide, multicenter longitudinal CKD registry, and included individuals with stage 3 and 4 CKD from 2014 to 2020 for the current analysis. We defined the variability of eGFR over a year using the coefficient of variation (eGFR-CV), standard deviation adjusted for the number of measurements (eGFR-adjSD), and average real variability (eGFR-ARV). The primary endpoint included the progression of CKD, defined as either a 40% decline in eGFR or the development of end-stage renal disease (ESRD).
Results
Of 24,986 participants, with an average age of 71.1 ± 11.8 years and 56.5% were male, the mean eGFR was calculated as 49.6 ± 7.8 ml/min/1.73m2, and the median coefficient of variation for eGFR (eGFR-CV) was 7.6% [IQR 5.2 – 11.7]. Over a follow-up period of 3.3 years, 1,324 (5.3%) participants experienced a 40% decline in eGFR and 647 (2.6%) developed ESRD. Higher eGFR variability was associated with an increased risk of CKD progression in all patients after adjusting for eGFR slope over a year, and eGFR and other covariates at baseline (Table). These results were similar when other variability indices (eGFR-SD, eGFR-adjSD, and eGFR-ARV) were used instead of eGFR-CV. Furthermore, incorporating eGFR-CV into a predictive model that already included proteinuria and eGFR slope improved the prediction of outcomes, as evidenced by an increase in Harrell’s c-index by 0.040 (95%CI 0.030 - 0.049, P<0.001).
Conclusion
eGFR variability is an independent predictor for CKD progression.
Funding
- Government Support – Non-U.S.