Decline in eGFR in CKD Patients versus At-risk Patients

There are few data available on estimated glomerular filtration rate (eGFR) decline in patients with chronic kidney disease (CKD) compared with those at risk for CKD. Researchers conducted an analysis of eGFR trajectories (eGFR-T) in those two patient populations, using data from the UCLA-PSJH (University of California, Los Angeles-Providence St. Joseph Health) CKD registry.

The cohort included more than 2.6 million adults, identified from laboratory results and/or administrative codes for diagnoses of CKD, hypertension, diabetes mellitus, or pre-diabetes. The current analysis included 84,150 patients with CKD and 807,211 patients at risk for CKD with three or more eGFRs ≥15 mL/min/1.73 m² followed for an average of 5.4 years.

Most patients were 45 to 64 years of age, 56% were female, and 83% were white non-Latino. In the CKD cohort 72% were ≥65 years of age (vs 36% in the at-risk CKD cohort). Patients in the CKD cohort had more diabetes (106% vs 18%) and hypertension (25% vs 18%) than those in the at-risk CKD cohort. Those with severe declines in eGFR (compared with non- and moderate-decliners) had higher baseline eGFR; 27% of the at-risk cohort progressed to eGFR ≤60 mL/min/1.73 m². The steepest eGFR-Ts were seen both CKD patients and at-risk CKD patients 18 to 44 years of age (eGFR-T, –5.22 and –4.26, respectively) compared with other age groups (P<0.001).

In linear mixed effects bivariate analyses, for all decliners there were differences in eGFR slopes by age, sex, and race/ethnicity. Annual change in eGFR was lowest in patients >45 years of age (P<0.001) and declined in females more than in males in both the CKD group (P=0.025) and the at-risk group (P<0.001). Compared with white non-Latino patients in the CKD group, eGFR-Ts were steepest for American Indian/Alaska Native patients (P=0.007); in the at-risk group, the steepest eGFR-Ts were among those of Native Hawaiian/Pacific Islander ethnicity.

“Patients with CKD are older, have more diabetes mellitus and hypertension, lower baseline eGFR and more rapid renal function decline compared to at-risk CKD patients,” the researchers said. “CKD and at-risk CKD severe decliners were youngest, with the highest baseline eGFR. The study results suggest a subset of young patients with high baseline eGFR may be important to target to prevent rapid renal function decline.”

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Source:  Nicholas SB, Norris KC, Li N, et al. eGFR decline in patients with CKD and at risk for CKD by age, gender, and race/ethnicity in two large health systems. Abstract of a poster presented at the American Society of Nephology Kidney Week 2019 (Abstract TH-PO419), November 7, 2019, Washington, DC.