Kidney Week

Abstract: TH-PO0643

Two-Year eGFR Slope and Association with Adverse Clinical Outcomes in Patients with CKD: Results from a Multinational Real-World Study

Session Information

• CKD: Clinical - Guidelines, Biomarkers, Progression, Procedures, Outcomes, and More
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Pecoits-Filho, Roberto, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil

Roberto Pecoits-Filho, MD, PhD, FASN

• Burton, James, University of Leicester, Leicester, United Kingdom

James Burton, MBChB, PhD, FASN

• Adamsson Eryd, Samuel, AstraZeneca, Gothenburg, Sweden

Samuel Adamsson Eryd, PhD

• Aranda, Unai, AstraZeneca, Gaithersburg, Maryland, United States

Unai Aranda

• Bodegard, Johan, RWE Research, Oslo, Norway

Johan Bodegard, MD, PhD

• Enxing, Joshua, AstraZeneca, Cambridge, United Kingdom

Joshua Enxing, MS, MSc

• Karlberg, Olof, Sence Research AB, Uppsala, Sweden

Olof Karlberg, PhD

• van Haalen, Heleen, AstraZeneca, Gothenburg, Sweden

Heleen van Haalen

• Levin, Adeera, University of British Columbia, Vancouver, British Columbia, Canada

Adeera Levin, MD

• Tuttle, Katherine R., Providence Health Care and University of Washington, Spokane, Washington, United States

Katherine R. Tuttle, MD, FASN

• Chang, Tara I., Stanford University School of Medicine, Stanford, California, United States

Tara I. Chang, MD, MS, FASN

• Svensson, Maria K., Uppsala University, Uppsala, Sweden

Maria K. Svensson, MD, PhD

Background

CKD is associated with high risks of kidney failure, cardiovascular events, heart failure and mortality. eGFR slope is a validated surrogate endpoint strongly predictive of kidney outcomes, including ESKD. We evaluated its association with adverse clinical outcomes in real-world CKD populations.

Methods

Adults with CKD were identified from healthcare databases in England (Clinical Practice Research Datalink Aurum) and the USA (Optum's de-identified Clinformatics^® Data Mart) using an index date of January 1, 2022, and from registries in Sweden using an index date of January 1, 2020. Patients with T1D, ESKD/kidney failure or pregnancy were excluded. Pre-index eGFR slopes were estimated using linear mixed effects models of repeated measurements (≥ 3 eGFR measurements over a 3-year period, first and last ≥ 90 days apart). Associations with outcomes were assessed using Cox models adjusted for age, sex, baseline eGFR and UACR, T2D and heart failure. Outcomes were severe kidney outcomes, cardiorenal (CKD or heart failure) hospitalizations, atherosclerotic cardiovascular disease, and all-cause death.

Results

We identified 219 598 patients from England, 39 128 from Sweden and 378 329 from the USA; across countries, 43–54% were women, the mean age was 71–75 years and eGFR slopes were based on 7–9 measurements over ~2.3–2.4 years. Compared with patients with a stable eGFR slope (+1 to −1 mL/min/1.73 m²/year), rapid eGFR decline (≤ −4) was associated with higher risks of severe kidney outcomes, cardiorenal hospitalizations, and all-cause death (Figure). A steeper decline (≤ −5) was also associated with increased risk of atherosclerotic cardiovascular disease.

Conclusion

In a multinational CKD population, 2-year eGFR slope is progressively associated with risks of incident severe kidney outcomes, cardiorenal hospitalizations, and death. These findings support the clinical utility of eGFR slope to identify high-risk patients and the implementation of therapies to slow disease progression.

Funding

• Commercial Support – AstraZeneca