Kidney Week

Abstract: SA-OR013

Association of eGFR Decline with Clinical Outcomes in Real-World US Patients with CKD

Session Information

• CKD: Advancing Epidemiology, Risk Factors, and Prevention
  November 08, 2025 | Location: Room 362A, Convention Center
  Abstract Time: 05:00 PM - 05:10 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Erickson, Kevin F., Baylor College of Medicine, Department of Medicine-Nephrology, Houston, Texas, United States

Kevin F. Erickson, MD, MS, FASN

• Modley, Ben, leads.healthcare, Staufen, Germany

Ben Modley, MSc

• Winkelmayer, Wolfgang C., Baylor College of Medicine, Department of Medicine-Nephrology, Houston, Texas, United States

Wolfgang C. Winkelmayer, MD, ScD, MPH, FASN

• Fotheringham, James, Sheffield University, School of Medicine and Population Health, Sheffield, United Kingdom

James Fotheringham, MBChB, PhD

• Zhang, Ling, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States

Ling Zhang, MD, MS, MPH

• Du, Chengan, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, United States

Chengan Du, PhD

• Steubl, Dominik, Boehringer Ingelheim International GmbH & Co. KG, Ingelheim am Rhein, Germany

Dominik Steubl, MD

• Wittrup-Jensen, Villum, Boehringer Ingelheim International GmbH & Co. KG, Ingelheim am Rhein, Germany

Villum Wittrup-Jensen

• Akehurst, Ronald L., Lumanity, London, United Kingdom

Ronald L. Akehurst

• Boersma, Cornelis, University of Groningen, Faculty of Medical Sciences, Groningen, Netherlands

Cornelis Boersma, PhD

• Postma, Maarten J., Health-Ecore B.V., Zeist, Netherlands

Maarten J. Postma, PhD

Background

Estimated glomerular filtration rate (eGFR) decline is a surrogate endpoint in clinical trials for chronic kidney disease (CKD) widely accepted by regulatory authorities as a valid predictor of kidney failure. However, uptake of eGFR decline in real-world practice as a formal indicator of adverse outcomes is limited. This study explored the clinical significance of a sustained ≥40% eGFR decline as a predictor of kidney failure and cardiovascular (CV) outcomes in real-world US patients.

Methods

We used US Optum Market Clarity database linked claims and electronic health records (10/2015–9/2023) to identify patients with CKD, defined as ≥2 eGFR measures <90 mL/min/1.73 m² within 1 year and ≥90 days apart. A baseline (BL) period of ≤3 years, based on a median follow-up of 2–2.4 years in CKD trials, was defined by the time from first eGFR value at start of baseline until ≥40% decline in eGFR (start of follow-up).1,2 To eliminate immortal time bias, controls without ≥40% eGFR decline were matched to cases at BL. Time-to-event analyses were conducted to estimate the incidence and rate ratios of kidney failure, CV death, and hospitalizations for myocardial infarction, heart failure, or stroke during follow-up in cases vs controls, adjusted for BL covariates.

Results

116,828 cases with ≥40% eGFR decline were matched to 414,084 controls. Mean follow-up was 3.4 years. Incidence rates of all study outcomes were >2-fold increased among cases vs controls (p<0.0001, Table 1).

Conclusion

These findings show a strong association between ≥40% eGFR decline over a 3-year period and longer-term adverse clinical outcomes in patients with CKD, thus supporting its potential as an effective risk predictor for kidney and CV complications and outcomes.

¹Heerspink HJL, et al. N Engl J Med. 2020;383(15):1436-1446.
²The E-KCG, et al. N Engl J Med. 2023;388(2):117-127.

Funding

• Commercial Support – Boehringer Ingelheim

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025s072vhcj