Publication

Past decline versus current EGFR and subsequent mortality risk

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  • 03/03/2025
Type of Material
Authors
    David M.J. Naimark, University of Toronto Faculty of MedicineMorgan E. Grams, Johns Hopkins Bloomberg School of Public HealthKunihiro Matsushita, Johns Hopkins Bloomberg School of Public HealthCorri Black, University of AberdeenIefke Drion, Isala ClinicsCaroline S. Fox, Framingham Heart StudyLesley A. Inker, Tufts Medical CenterAreef Ishani, Minneapolis Veterans Affairs Health Care SystemSun Ha Jee, Yonsei UniversityAkihiko Kitamura, Osaka Center for Cancer and Cardiovascular Disease PreventionJanice Lea, Emory UniversityJoseph Nally, Cleveland Clinic FoundationCarmen Alicia Peralta, VA Medical CenterDietrich Rothenbacher, German Cancer Research CenterSeungho Ryu, Samsung GroupMarcello Tonelli, University of CalgaryHiroshi Yatsuya, Fujita Health UniversityJosef Coresh, Johns Hopkins Bloomberg School of Public HealthRon T. Gansevoort, University of Groningen, University Medical Center GroningenDavid G. Warnock, University of Alabama at BirminghamMark Woodward, Johns Hopkins Bloomberg School of Public HealthPaul E. de Jong, University of Groningen, University Medical Center Groningen
Language
  • English
Date
  • 2016-01-01
Publisher
  • American Society of Nephrology
Publication Version
Copyright Statement
  • © 2016 by the American Society of Nephrology
Final Published Version (URL)
Title of Journal or Parent Work
ISSN
  • 1046-6673
Volume
  • 27
Issue
  • 8
Start Page
  • 2456
End Page
  • 2466
Supplemental Material (URL)
Abstract
  • A single determination of EGFR associates with subsequent mortality risk. Prior decline in EGFR indicates loss of kidney function, but the relationship tomortality risk is uncertain. We conducted an individual-level meta-analysis of the risk ofmortality associatedwith antecedent EGFR slope, adjusting for established risk factors, including last EGFR, among 1.2million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an EGFR slope,25ml/min per 1.73 m2 per year, whereas 7%and 4% had a slope .5 ml/min per 1.73 m2 per year, respectively. Compared with a slope of 0 ml/min per 1.73 m2 per year, a slope of 26 ml/min per 1.73 m2 per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI] , 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m2 per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus ,3 years). We conclude that prior decline or rise in EGFR associates with an increased risk of mortality, independent of current EGFR.
Author Notes
  • The Chronic Kidney Disease Prognosis Consortium (CKD-PC) Data Coordinating Center is funded, in part, by a program grant from the US National Kidney Foundation (funding sources include AbbVie and Amgen, Inc.) and National Institute of Diabetes and Digestive and Kidney Diseases Grant R01DK100446-01. A variety of sources have supported enrollment and data collection, including laboratory measurements, as well as follow-up in the collaborating cohorts of the CKD-PC. These funding sources include government agencies, such as the National Institutes of Health, and medical research councils as well as foundations and industry sponsors, and they are listed in Supplemental Appendix 3. Individual cohort and collaborator support is listed in Supplemental Appendix 3. The funders had no role in the design, analysis, or interpretation of this study and did not contribute to the writing of this report or the decision to submit the article for publication. Group members are listed by study. African American Study of Kidney Disease and Hypertension: Jackson T. Wright Jr., Case Western Reserve University; Lawrence J. Appel, Johns Hopkins University; Tom Greene, University of Utah; and Brad C. Astor, University of Wisconsin. The Action in Diabetes and Vascular Disease Study: Preterax and Diamicron Modified Release Controlled Evaluation: Stephen MacMahon, George Institute; John Chalmers, George Institute; Hisatomi Arima, George Institute; and M.W., George Institute, University of Oxford, University of Sydney, and Johns Hopkins Bloomberg School of Public Health. Aichi Workers’ Cohort: H.Y., Fujita Health University; Kentaro Yamashita, Nagoya Medical Center; Hideaki Toyoshima, Anjo Kosei Hospital; and Koji Tamakoshi, Nagoya University. Alberta Kidney Disease Network: M.T., University of Calgary; Brenda Hemmelgarn, University of Calgary; Matt James, University of Calgary; and Tanvir Chowdhury Turin, University of Calgary. Atherosclerosis Risk in Communities Study: J.C., Johns Hopkins University; K.M., Johns Hopkins University; M.E.G., Johns Hopkins University; and Yingying Sang, Johns Hopkins University. Australian Diabetes, Obesity, and Lifestyle Study (AusDiab): Robert C. Atkins, Monash University; Kevan R. Polkinghorne, Monash University; and Steven Chadban, University of Sydney. Beaver Dam CKD: Anoop Shankar; Ronald Klein, University of Wisconsin; Barbara E.K. Klein, University of Wisconsin; and Kristine E. Lee, University of Wisconsin. British Columbia CKD Study: Adeera Levin, British Columbia Provincial Renal Agency and University of British Columbia and Ognjenka Djurdjev, British Columbia Provincial Renal Agency and Provincial Health Services. The Cholesterol and Recurrent Events Trial: M.T., University of Calgary; Frank M. Sacks, Harvard School of Public Health; and Gary C. Curhan, Channing Division of Network Medicine/Renal Division, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health. Cardiovascular and Renal Outcome in CKD 2–4 Patients - The Fourth Homburg evaluation (CARE for HOMe): Adam M. Zawada, Saarland University Medical Center; Kyrill S. Rogacev, Saarland University Medical Center; Sarah Seiler, Saarland University Medical Center; and Gunnar H. Heine, Saarland University Medical Center. Cleveland Clinic CKD Registry Study: Sankar D. Navaneethan, Cleveland Clinic; J.N., Glickman Urological and Kidney Institute; and Jesse D. Schold, Cleveland Clinic. Cardiovascular Health Study: Michael Shlipak, University of California, San Francisco and San Francisco Veterans Affairs Medical Center; Mark J. Sarnak, Tufts Medical Center; and Ronit Katz, University of Washington. Circulatory Risk in Communities Study: Hiroyasu Iso, Osaka University; A.K., Osaka Center for Cancer and Cardiovascular Disease Prevention; Hironori Imano, Osaka University; and Kazumasa Yamagishi, University of Tsukuba. Chronic Renal Impairment in Birmingham: David C. Wheeler, University College London; Jonathan Emberson, University of Oxford; Jonathan N. Townend, Queen Elizabeth Hospital Birmingham; and Martin J. Landray, University of Oxford. Epidemiologische Studie zu Chancen der Verhuetung, Frueherkennung und optimierten Therapie chronischer Erkrankungen in der aelteren Bevölkerung (ESTHER): D.R., German Cancer Research Center and Ulm University; Hermann Brenner, German Cancer Research Center; Heiko Müller, German Cancer Research Center; and Ben Schöttker, German Cancer Research Center. Framingham Heart Study: C.S.F., Center for Population Studies and Brigham and Women’s Hospital and Harvard Medical School; Shih-Jen Hwang, National Heart, Lung, and Blood Institute; James B. Meigs, Massachusetts General Hospital; and Ashish Uphadhay, Boston University Medical Center. Geisinger CKD Study: Jamie Green, Geisinger Medical Center; H. Lester Kirchner, Geisinger Medical Center; Robert Perkins, Geisinger Medical Center; and Alex R. Chang, Geisinger Medical Center. Grampian Laboratory Outcomes, Morbidity and Mortality Study 1: C.B., University of Aberdeen; Angharad Marks, University of Aberdeen; Nick Fluck, National Health Service (NHS) Grampian; and Gordon J. Prescott, University of Aberdeen. Gubbio: Massimo Cirillo, University of Salerno. The Nord-Trøndelag Health Study: Stein Hallan, Norwegian University of Science and Technology and St. Olav University; Knut Aasarød, Norwegian University of Science and Technology and St. Olav University Hospital; Cecilia M. Øien, Norwegian University of Science and Technology; and Maria Radtke, Norwegian University of Science and Technology and St. Olavs University Hospital. Ibaraki Prefectural Health Study: Fujiko Irie, Ibaraki Prefectural Office; Hiroyasu Iso, Osaka University; Toshimi Sairenchi, Dokkyo Medical University School of Medicine; and Kazumasa Yamagishi, University of Tsukuba. Kaiser Permanente Northwest: David H. Smith, Kaiser Permanente Northwest; Micah L. Thorp, Kaiser Permanente Northwest; and Eric S. Johnson, Kaiser Permanente Northwest. Kaiser Permanente Hawaii Cohort: Brian J. Lee, Kaiser Permanente Hawaii Region. Kangbuk Samsung Health Study: Eliseo Guallar, Johns Hopkins University; S.R., Sunkgyunkwan University School of Medicine; Yoosoo Chang, Kangbuck Samsung Hospital, Sungkyunkwan University, School of Medicine; Juhee Cho, Sungkyunkwan University; and Hocheol Shin, Kangbuck Samsung Hospital, Sungkyunkwan University, School of Medicine. Maccabi: Gabriel Chodick, Maccabi Healthcare Services; Varda Shalev, Maccabi Healthcare Services and Tel Aviv University; Yair C. Birnbaum, Maccabi Healthcare Services; and Bracha Shainberg, Maccabi Healthcare Services. Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of a Nurse Practitioner Study: Jack F.M. Wetzels, Radboud University Medical Centre; Peter J. Blankestijn, University Medical Center Utrecht; and Arjan D. van Zuilen, University Medical Center Utrecht. Modification of Diet in Renal Disease Study: Mark J. Sarnak, Tufts Medical Center; Andrew S. Levey, Tufts Medical Center; L.A.I, Tufts Medical Center; and Vandana Menon, Tufts Medical Center. Multi-Ethnic Study of Atherosclerosis: Michael Shlipak, University of California, San Francisco and San Francisco Veterans Affairs Medical Center; Mark J. Sarnak, Tufts Medical Center; Ronit Katz, University of Washington; and C.A.P., University of California and San Francisco Veterans Affairs Medical Center. Multiple Risk Factor Intervention Trial: A.I., Minneapolis Veterans Affairs Health Care System; and James D. Neaton, University of Minnesota. NephroTestStudy: Marc Froissart, Institut National de la Santé et de la Recherche Médicale (Inserm) U1018; Benedicte Stengel, Inserm U1018, University of Paris Sud, and Université Versailles Saint Quentin (USVQ); Marie Metzger, Inserm U1018 and University of Paris Sud-11; Jean-Philippe Haymann, Sorbonne Universités, Université Pierre et Marie Curie University of Paris 06, Assistance Publique-Hôpitaux de Paris; Pascal Houillier, Assistance Publique-Hôpitaux de Paris, Paris Descartes University; and Martin Flamant, Assistance Publique-Hôpitaux de Paris. New Zealand Diabetes Cohort Study: C. Raina Elley, University of Auckland; Timothy Kenealy, University of Auckland; Simon A. Moyes, University of Auckland; John F. Collins, Auckland District Health Board; and Paul L. Drury, Auckland District Health Board. Ohasama Study: Takayoshi Ohkubo, Teikyo University; Hirohito Metoki, Tohoku University; Masaaki Nakayama, Fukushima Medical University; Masahiro Kikuya, Tohoku University; and Yutaka Imai, Tohoku University. Okinawa 83/93: Kunitoshi Iseki, University Hospital of the Ryukyus. Pima Indian Study: Robert G. Nelson, National Institute of Diabetes and Digestive and Kidney Diseases; and William C. Knowler, National Institute of Diabetes and Digestive and Kidney Diseases. Prevention of Renal and Vascular Endstage Disease Study: R.T.G., University Medical Center Groningen; Stephan J.L. Bakker, University Medical Center Groningen; Hans L. Hillege, University Medical Center Groningen; and Pim van der Harst, University Medical Center Groningen. Rancho Bernardo Study: Simerjot K. Jassal, University of California, San Diego and Veterans Affairs San Diego Healthcare; Jaclyn Bergstrom, University of California, San Diego; Joachim H. Ix, University of California, San Diego and Veterans Affairs San Diego Healthcare; and Elizabeth Barrett-Connor, University of California, San Diego. Reduction of Endpoints in Non-Insulin Dependent Diabetes Mellitus with the Angiotensin II Antagonist Losartan: Hiddo J. Lambers Heerspink, University of Groningen; Barry E. Brenner, Brigham and Women's Hospital and Harvard School of Medicine; and Dick de Zeeuw, University of Groningen. Severance Cohort Study: S.H.J., Yonsei University; Heejin Kimm, Yonsei University; and Yejin Mok, Yonsei University. Sunnybrook Cohort: Navdeep Tangri, University of Manitoba; Maneesh Sud, University of Toronto; and D.N., University of Toronto. Taiwan MJ Cohort Study: Chi-Pang Wen, China Medical University Hospital; Sung-Feng Wen, University of Wisconsin; Chwen-Keng Tsao, MJ Health Management Institution; and Min-Kuang Tsai, National Health Research Institutes. ULSAM: Johan Ärnlöv, Uppsala University; Lars Lannfelt, Uppsala University; and Anders Larsson, Uppsala University. Veterans Administration CKD Study: Csaba P. Kovesdy, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center; and Kamyar Kalantar-Zadeh, University of California Irvine Medical Center. Zwolle Outpatient Diabetes Project Integrating Available Care: Henk J. Bilo, Isala Clinics; Nanno Kleefstra, Isala Clinics; Klaas H. Groenier, Isala Clinics; Hanneke Joosten, Isala Clinics; and I.D., Isala Clinics. CKD-PC Steering Committee: J.C., Johns Hopkins Bloomberg School of Public Health; R.T.G., University Medical Center Groningen; P.E.d.J., University Medical Center Groningen; Kunitoshi Iseki, University Hospital of the Ryukyus; Andrew S. Levey, Tufts Medical Center; K.M., Johns Hopkins Bloomberg School of Public Health; Mark J. Sarnak, Tufts Medical Center; Benedicte Stengel, l'Institut National de la Santé et de la Recherche Médicale U1018, University of Paris Sud, and l'Université Versailles Saint Quentin (USVQ); D.G.W., University of Alabama at Birmingham; and M.W., George Institute, University of Oxford, University of Sydney, and Johns Hopkins Bloomberg School of Public Health. CKD-PC Data Coordinating Center: Shoshana H. Ballew (Coordinator), Johns Hopkins Bloomberg School of Public Health; J.C. (Principal Investigator), Johns Hopkins Bloomberg School of Public Health; M.E.G. (Director of Nephrology Initiatives), Johns Hopkins Bloomberg School of Public Health; K.M. (Director), Johns Hopkins Bloomberg School of Public Health; Yingying Sang (Lead Programmer), Johns Hopkins Bloomberg School of Public Health; and M.W. (Senior Statistician), George Institute, University of Oxford, University of Sydney, and Johns Hopkins Bloomberg School of Public Health.
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