TY - JOUR
T1 - Risk of ESRD and Mortality Associated With Change in Filtration Markers
AU - Rebholz, Casey M.
AU - Inker, Lesley A.
AU - Chen, Yuan
AU - Liang, Menglu
AU - Foster, Meredith C.
AU - Eckfeldt, John H.
AU - Kimmel, Paul L.
AU - Vasan, Ramachandran S.
AU - Feldman, Harold I.
AU - Sarnak, Mark J.
AU - Hsu, Chi yuan
AU - Levey, Andrew S.
AU - Coresh, Josef
N1 - Publisher Copyright:
© 2017 National Kidney Foundation, Inc.
PY - 2017/10
Y1 - 2017/10
N2 - Background Using change in estimated glomerular filtration rate (eGFR) based on creatinine concentration as a surrogate outcome in clinical trials of chronic kidney disease has been proposed. Risk for end-stage renal disease (ESRD) and all-cause mortality associated with change in concentrations of other filtration markers has not been studied in chronic kidney disease populations. Study Design Observational analysis of 2 clinical trials. Setting & Participants Participants in the MDRD (Modification of Diet in Renal Disease; n = 317) Study and AASK (African American Study of Kidney Disease and Hypertension; n = 373). Predictors Creatinine, cystatin C, β-trace protein (BTP), and β2-microglobulin (B2M) were measured in serum samples collected at the 12- and 24-month follow-up visits, along with measured GFR (mGFR) at these time points. Outcomes ESRD and all-cause mortality. Measurements Poisson regression was used to estimate incidence rate ratios and 95% CIs for ESRD and all-cause mortality during long-term follow-up (10-16 years) per 30% decline in mGFR or eGFR for each filtration marker and the average of all 4 markers. Results 1-year decline in mGFR, eGFRcr, eGFRBTP, and the average of the 4 filtration markers was significantly associated with increased risk for incident ESRD in both studies (all P ≤ 0.02). Compared to mGFR, only decline in eGFRBTP was statistically significantly more strongly associated with ESRD risk in both studies (both P ≤ 0.03). Decline in eGFRcr, but not mGFR or the other filtration markers, was significantly associated with risk for all-cause mortality in AASK only (incidence rate ratio per 30% decline, 4.17; 95% CI, 1.78-9.74; P < 0.001), but this association was not significantly different from decline in mGFR (P = 0.2). Limitations Small sample size. Conclusions Declines in mGFR, eGFRcr, eGFRBTP, and the average of 4 filtration markers (creatinine, cystatin C, BTP, and B2M) were consistently associated with progression to ESRD.
AB - Background Using change in estimated glomerular filtration rate (eGFR) based on creatinine concentration as a surrogate outcome in clinical trials of chronic kidney disease has been proposed. Risk for end-stage renal disease (ESRD) and all-cause mortality associated with change in concentrations of other filtration markers has not been studied in chronic kidney disease populations. Study Design Observational analysis of 2 clinical trials. Setting & Participants Participants in the MDRD (Modification of Diet in Renal Disease; n = 317) Study and AASK (African American Study of Kidney Disease and Hypertension; n = 373). Predictors Creatinine, cystatin C, β-trace protein (BTP), and β2-microglobulin (B2M) were measured in serum samples collected at the 12- and 24-month follow-up visits, along with measured GFR (mGFR) at these time points. Outcomes ESRD and all-cause mortality. Measurements Poisson regression was used to estimate incidence rate ratios and 95% CIs for ESRD and all-cause mortality during long-term follow-up (10-16 years) per 30% decline in mGFR or eGFR for each filtration marker and the average of all 4 markers. Results 1-year decline in mGFR, eGFRcr, eGFRBTP, and the average of the 4 filtration markers was significantly associated with increased risk for incident ESRD in both studies (all P ≤ 0.02). Compared to mGFR, only decline in eGFRBTP was statistically significantly more strongly associated with ESRD risk in both studies (both P ≤ 0.03). Decline in eGFRcr, but not mGFR or the other filtration markers, was significantly associated with risk for all-cause mortality in AASK only (incidence rate ratio per 30% decline, 4.17; 95% CI, 1.78-9.74; P < 0.001), but this association was not significantly different from decline in mGFR (P = 0.2). Limitations Small sample size. Conclusions Declines in mGFR, eGFRcr, eGFRBTP, and the average of 4 filtration markers (creatinine, cystatin C, BTP, and B2M) were consistently associated with progression to ESRD.
KW - Beta-2-microglobulin (B2M)
KW - beta trace protein (BTP)
KW - creatinine
KW - cystatin C
KW - death
KW - end-stage renal disease (ESRD)
KW - estimated GFR
KW - filtration markers
KW - glomerular filtration rate (GFR)
KW - incident ESRD
KW - kidney function decline
KW - measured GFR
KW - mortality
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U2 - 10.1053/j.ajkd.2017.04.025
DO - 10.1053/j.ajkd.2017.04.025
M3 - Article
C2 - 28648303
AN - SCOPUS:85021088339
SN - 0272-6386
VL - 70
SP - 551
EP - 560
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -
