Format

Send to

Choose Destination
J Am Soc Nephrol. 2019 Sep;30(9):1756-1769. doi: 10.1681/ASN.2019010009. Epub 2019 Jul 10.

Performance of GFR Slope as a Surrogate End Point for Kidney Disease Progression in Clinical Trials: A Statistical Simulation.

Author information

1
Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
2
Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
3
Institute for Clinical Research and Health Policy Studies and.
4
Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts.
5
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
6
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
7
Nakayamadera Imai Clinic, Takarazuka, Japan.
8
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
9
Duke Global Health Institute, Duke University, Durham, North Carolina.
10
AZ Delta, Roeselare, Belgium.
11
Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, Lecco, Italy.
12
Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; and.
13
Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands.
14
Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; LInker@tuftsmedicalcenter.org.

Abstract

BACKGROUND:

Randomized trials of CKD treatments traditionally use clinical events late in CKD progression as end points. This requires costly studies with large sample sizes and long follow-up. Surrogate end points like GFR slope may speed up the evaluation of new therapies by enabling smaller studies with shorter follow-up.

METHODS:

We used statistical simulations to identify trial situations where GFR slope provides increased statistical power compared with the clinical end point of doubling of serum creatinine or kidney failure. We simulated GFR trajectories based on data from 47 randomized treatment comparisons. We evaluated the sample size required for adequate statistical power based on GFR slopes calculated from baseline and from 3 months follow-up.

RESULTS:

In most scenarios where the treatment has no acute effect, analyses of GFR slope provided similar or improved statistical power compared with the clinical end point, often allowing investigators to shorten follow-up by at least half while simultaneously reducing sample size. When patients' GFRs are higher, the power advantages of GFR slope increase. However, acute treatment effects within several months of randomization can increase the risk of false conclusions about therapies based on GFR slope. Care is needed in study design and analysis to avoid such false conclusions.

CONCLUSIONS:

Use of GFR slope can substantially increase statistical power compared with the clinical end point, particularly when baseline GFR is high and there is no acute effect. The optimum GFR-based end point depends on multiple factors including the rate of GFR decline, type of treatment effect and study design.

KEYWORDS:

CKD progression; GFR slope; end stage kidney disease; simulation studies

PMID:
31292198
PMCID:
PMC6727266
[Available on 2020-09-01]
DOI:
10.1681/ASN.2019010009

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center