Abstract: FR-PO1134
Variability in eGFR and Adverse Kidney Outcomes in Routine Clinical Practice
Session Information
- CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Sasaki, Takaya, The George Institute for Global Health, Sydney, New South Wales, Australia
- Buizen, Luke, The George Institute for Global Health, Sydney, New South Wales, Australia
- Harris, Katie, The George Institute for Global Health, Sydney, New South Wales, Australia
- Badve, Sunil, The George Institute for Global Health, Sydney, New South Wales, Australia
- Chalmers, John P., The George Institute for Global Health, Sydney, New South Wales, Australia
- Gallagher, Martin P., The George Institute for Global Health, Sydney, New South Wales, Australia
- Ha, Jeffrey Tsun Kit, The George Institute for Global Health, Sydney, New South Wales, Australia
- Jardine, Meg, The George Institute for Global Health, Sydney, New South Wales, Australia
- Ketema, Daniel Bekele, The George Institute for Global Health, Sydney, New South Wales, Australia
- Kotwal, Sradha S., The George Institute for Global Health, Sydney, New South Wales, Australia
- Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia
- Ronksley, Paul E., University of Calgary, Calgary, Alberta, Canada
- Wallace, Hannah, The George Institute for Global Health, Sydney, New South Wales, Australia
- Yokoo, Takashi, Tokyo Jikeikai Ika Daigaku, Minato, Tokyo, Japan
- Woodward, Mark, The George Institute for Global Health, Sydney, New South Wales, Australia
- Jun, Min, The George Institute for Global Health, Sydney, New South Wales, Australia
Background
Variability in estimated glomerular filtration rate (eGFR) may indicate underlying kidney instability, but its prognostic value for kidney disease progression in routine primary care remains insufficiently studied.
Methods
We conducted a retrospective cohort study using MedicineInsight, an Australian primary care database. Adults (≧18 years) with ≧3 eGFR measurements over 3 years (2011-2018) were included. eGFR variability was measured using the coefficient of variation (CV) and categorized using quintiles. The primary outcome was a composite of sustained ≧40% eGFR decline, sustained eGFR <15 mL/min/1.73 m2, or all-cause mortality, assessed over a 3-year follow-up period. Cox proportional hazards models were adjusted for mean eGFR, eGFR slope, demographics, comorbidities, and medications.
Results
Among 754,306 patients (mean age 59.1 years, 58.0% female), 14,239 (1.9%) experienced the composite kidney outcome. The cumulative incidence of the composite outcome increased significantly in accordance with higher eGFR variability (Figure). Compared with the lowest fifth, patients in the highest fifth had a significantly increased risk (adjusted hazard ratio: 2.17 [95% CI: 2.03-2.32]; P <0.001). These associations were consistent across subgroups stratified by age, sex, hypertension, diabetes, and baseline eGFR, and remained robust in sensitivity analyses. When treated as a continuous variable, eGFR variability showed a positive, log-linear association with the adverse outcomes, particularly with all-cause mortality and ≧40% eGFR decline.
Conclusion
Greater eGFR variability was independently associated with increased risk of adverse kidney outcomes and mortality in a large, unselected primary care cohort. Incorporating eGFR variability into routine assessments may improve risk stratification and guide earlier interventions to slow chronic kidney disease progression.
Figure
Funding
- Commercial Support – This study was supported by the Renal Division of The George Institute for Global Health, which is supported by the University of New South Wales Scientia Program and a sponsorship provided by Boehringer Ingelheim and Eli Lilly Alliance.