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Multicenter Study
. 2014 Feb;63(2):236-43.
doi: 10.1053/j.ajkd.2013.08.028. Epub 2013 Oct 30.

Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study

Wei Yang  1 , Dawei Xie  2 , Amanda H Anderson  2 , Marshall M Joffe  2 , Tom Greene  3 , Valerie Teal  2 , Chi-yuan Hsu  4 , Jeffrey C Fink  5 , Jiang He  6 , James P Lash  7 , Akinlolu Ojo  8 , Mahboob Rahman  9 , Lisa Nessel  2 , John W Kusek  10 , Harold I Feldman  2 ; CRIC Study Investigators
Collaborators, Affiliations
Multicenter Study

Association of kidney disease outcomes with risk factors for CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study

Wei Yang et al. Am J Kidney Dis. 2014 Feb.

Abstract

Background: Various indicators of progression of chronic kidney disease (CKD) have been used as outcomes in clinical research studies. The effect of using varying measures on the association of risk factors with CKD progression has not been well characterized.

Study design: Prospective cohort study.

Setting & participants: The Chronic Renal Insufficiency Cohort (CRIC) Study (N=3,939) enrolled men and women with mild to moderate CKD, 48% of whom had diabetes and 42% were self-reported black race.

Predictors: Age, race, sex, diabetes, baseline estimated glomerular filtration rate (eGFR), proteinuria, and other established CKD risk factors.

Outcomes: Death, end-stage renal disease (ESRD), and eGFR events, including: (1) eGFR halving, (2) eGFR<15mL/min/1.73m(2), (3) eGFR halving and <15mL/min/1.73m(2), (4) eGFR decrease of 20mL/min/1.73m(2), (5) eGFR halving or decrease of 20mL/min/1.73m(2), and (6) eGFR decrease of 25% and change in CKD stage.

Results: Mean entry eGFR was 44.9mL/min/1.73m(2). Annual rates of death, ESRD, and eGFR halving were 2.5%, 4.0%, and 6.1%, respectively, during an average follow-up of 5.4 years. Associations between risk factors and ESRD and eGFR events were similar across different definitions. However, these associations were substantially different from those with death. HRs for ESRD, eGFR halving, and death in the highest compared to the lowest proteinuria category were 11.83 (95% CI, 8.40-16.65), 11.19 (95% CI, 8.53-14.68), and 1.47 (95% CI, 1.10-1.96), respectively.

Limitations: Participants may not be representative of the entire CKD population.

Conclusions: Using ESRD or eGFR events, but not death, in the definition of kidney disease outcomes is appropriate in follow-up studies to identify risk factors for CKD progression.

Keywords: Chronic Renal Insufficiency Cohort (CRIC); Kidney disease progression; chronic kidney disease (CKD); decreased estimated glomerular filtration rate (eGFR); disease trajectory; end-stage renal disease (ESRD); estimated glomerular filtration rate (eGFR); longitudinal outcome; mortality risk; renal function.

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Figures

Figure 1
Figure 1
An eGFR halving event can occur in a time interval bracketed by: two clinic visits; a clinic visit and an ESRD event; a participants’ last clinic visit and death; or a participants’ last clinic visit and the end of the follow up period, which may be either the date of withdrawal from the study or the cutoff date for the analyses.
Figure 1
Figure 1
An eGFR halving event can occur in a time interval bracketed by: two clinic visits; a clinic visit and an ESRD event; a participants’ last clinic visit and death; or a participants’ last clinic visit and the end of the follow up period, which may be either the date of withdrawal from the study or the cutoff date for the analyses.
Figure 1
Figure 1
An eGFR halving event can occur in a time interval bracketed by: two clinic visits; a clinic visit and an ESRD event; a participants’ last clinic visit and death; or a participants’ last clinic visit and the end of the follow up period, which may be either the date of withdrawal from the study or the cutoff date for the analyses.
Figure 1
Figure 1
An eGFR halving event can occur in a time interval bracketed by: two clinic visits; a clinic visit and an ESRD event; a participants’ last clinic visit and death; or a participants’ last clinic visit and the end of the follow up period, which may be either the date of withdrawal from the study or the cutoff date for the analyses.
Figure 2
Figure 2
eGFR imputation in the first and second type of intervals. In the former, the time of eGFR halving is estimated by drawing a line between the two eGFR values; in the latter, the eGFR value at the time of ESRD is imputed as 10.9 ml/min/1.73 m2 and the time of eGFR halving is then estimated the same way as in the first example.
Figure 2
Figure 2
eGFR imputation in the first and second type of intervals. In the former, the time of eGFR halving is estimated by drawing a line between the two eGFR values; in the latter, the eGFR value at the time of ESRD is imputed as 10.9 ml/min/1.73 m2 and the time of eGFR halving is then estimated the same way as in the first example.
Figure 3
Figure 3
Multivariable adjusted hazard ratios and 95% confidence intervals for death. The reference groups are 21–44 years for age, white for race and male for gender. Y-axis was plotted in natural log scale with labels in the original scale. Models additionally included ankle-brachial index, uric acid, history of CVD, BMI, hypertension, hemoglobin, education and smoking status.
Figure 4
Figure 4
Multivariable adjusted hazard ratios and 95% confidence intervals for eGFR events. Renal 1: eGFR halving from baseline. Renal 2: GFR<15 ml/min/1.73m2. Renal 3: eGFR halving from baseline and <15 ml/min/1.73m2. Renal 4: eGFR decrease of 20 ml/min/1.73m2 from baseline. Renal 5: eGFR halving or decrease of 20 ml/min/1.73m2 from baseline. Renal 6: eGFR decrease of 25% from baseline and change of CKD stage. The reference groups are 21–44 years for age, white for race and male for gender. Y-axis was plotted in natural log scale with labels in the original scale. Models additionally included ankle-brachial index, uric acid, history of CVD, BMI, hypertension, hemoglobin, education and smoking status.
Figure 4
Figure 4
Multivariable adjusted hazard ratios and 95% confidence intervals for eGFR events. Renal 1: eGFR halving from baseline. Renal 2: GFR<15 ml/min/1.73m2. Renal 3: eGFR halving from baseline and <15 ml/min/1.73m2. Renal 4: eGFR decrease of 20 ml/min/1.73m2 from baseline. Renal 5: eGFR halving or decrease of 20 ml/min/1.73m2 from baseline. Renal 6: eGFR decrease of 25% from baseline and change of CKD stage. The reference groups are 21–44 years for age, white for race and male for gender. Y-axis was plotted in natural log scale with labels in the original scale. Models additionally included ankle-brachial index, uric acid, history of CVD, BMI, hypertension, hemoglobin, education and smoking status.
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References

    1. Wright JT, Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002 Nov 20;288(19):2421–2431. - PubMed
    1. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. The New England journal of medicine. 1994 Mar 31;330(13):877–884. - PubMed
    1. Agodoa LY, Appel L, Bakris GL, et al. Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA. 2001 Jun 6;285(21):2719–2728. - PubMed
    1. Levey AS, Greene T, Beck GJ, et al. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. Journal of the American Society of Nephrology. 1999 Nov;10(11):2426–2439. - PubMed
    1. Wang X, Lewis J, Appel L, et al. Validation of creatinine-based estimates of GFR when evaluating risk factors in longitudinal studies of kidney disease. Journal of the American Society of Nephrology. 2006 Oct;17(10):2900–2909. - PubMed

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