Format

Send to

Choose Destination
Am J Kidney Dis. 2017 Oct;70(4):551-560. doi: 10.1053/j.ajkd.2017.04.025. Epub 2017 Jun 23.

Risk of ESRD and Mortality Associated With Change in Filtration Markers.

Author information

1
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: crebhol1@jhu.edu.
2
William B. Schwartz Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA.
3
Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
4
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
5
Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, MN.
6
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
7
Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA; Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA.
8
Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
9
Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA.

Abstract

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.

KEYWORDS:

Beta-2-microglobulin (B2M); beta trace protein (BTP); creatinine; cystatin C; death; end-stage renal disease (ESRD); estimated GFR; filtration markers; glomerular filtration rate (GFR); incident ESRD; kidney function decline; measured GFR; mortality

PMID:
28648303
PMCID:
PMC5610931
DOI:
10.1053/j.ajkd.2017.04.025
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center