Visit-to-visit variability in estimated glomerular filtration rate predicts hospitalization and death due to cardiovascular events

Akira Suzuki, Yoshitsugu Obi, Terumasa Hayashi, Naoto Kotani, Yukari Uemura, Enyu Imai, Hirofumi Makino, Akira Hishida

Research output: Contribution to journalArticle

Abstract

Background: Greater variability in estimated glomerular filtration rate (eGFR) is associated with mortality in patients with chronic kidney disease (CKD). However, the association between eGFR variability and cardiovascular (CV) mortality and/or end-stage kidney disease (ESKD) in the CKD population is not very clear. This study aimed to clarify whether such an association exists. Methods: We analyzed a final cohort of 2869 eligible Asian patients with CKD. Patients were stratified into three groups according to eGFR variability during the first year and were followed-up for a median of 3.15 years. Primary CV composite endpoints were hospitalization or death due to CV events, and renal composite endpoints were doubling of serum creatinine levels or ESKD. Multivariate Cox hazard models adjusted for classical risk factors and eGFR slope were used to examine the CV and renal risk associated with eGFR variability. Results: CV endpoints were observed in 14 (2.89%), 25 (5.69%), and 41 (10.79%) patients and renal endpoints were observed in 165 (27.6%), 235 (39.0%), and 298 patients (50.9%) in the lowest, intermediate, and highest tertiles of eGFR variability, respectively. Patients in the highest tertile were at a significantly higher risk for CV events (hazard ratio 1.90; 95% confidence interval 1.03–3.71) than those in the lowest tertile. However, there was no association between eGFR variability and renal endpoints. Conclusions: Variability in eGFR can predict CV outcomes among patients with CKD.

Original languageEnglish
JournalClinical and Experimental Nephrology
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Glomerular Filtration Rate
Hospitalization
Chronic Renal Insufficiency
Kidney
Proportional Hazards Models
Chronic Kidney Failure
Mortality
Creatinine
Confidence Intervals
Serum
Population

Keywords

  • Cardiovascular mortality
  • Chronic kidney disease
  • End-stage kidney disease
  • Estimated glomerular filtration rate
  • Variability

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Visit-to-visit variability in estimated glomerular filtration rate predicts hospitalization and death due to cardiovascular events. / Suzuki, Akira; Obi, Yoshitsugu; Hayashi, Terumasa; Kotani, Naoto; Uemura, Yukari; Imai, Enyu; Makino, Hirofumi; Hishida, Akira.

In: Clinical and Experimental Nephrology, 01.01.2019.

Research output: Contribution to journalArticle

Suzuki, Akira ; Obi, Yoshitsugu ; Hayashi, Terumasa ; Kotani, Naoto ; Uemura, Yukari ; Imai, Enyu ; Makino, Hirofumi ; Hishida, Akira. / Visit-to-visit variability in estimated glomerular filtration rate predicts hospitalization and death due to cardiovascular events. In: Clinical and Experimental Nephrology. 2019.
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abstract = "Background: Greater variability in estimated glomerular filtration rate (eGFR) is associated with mortality in patients with chronic kidney disease (CKD). However, the association between eGFR variability and cardiovascular (CV) mortality and/or end-stage kidney disease (ESKD) in the CKD population is not very clear. This study aimed to clarify whether such an association exists. Methods: We analyzed a final cohort of 2869 eligible Asian patients with CKD. Patients were stratified into three groups according to eGFR variability during the first year and were followed-up for a median of 3.15 years. Primary CV composite endpoints were hospitalization or death due to CV events, and renal composite endpoints were doubling of serum creatinine levels or ESKD. Multivariate Cox hazard models adjusted for classical risk factors and eGFR slope were used to examine the CV and renal risk associated with eGFR variability. Results: CV endpoints were observed in 14 (2.89{\%}), 25 (5.69{\%}), and 41 (10.79{\%}) patients and renal endpoints were observed in 165 (27.6{\%}), 235 (39.0{\%}), and 298 patients (50.9{\%}) in the lowest, intermediate, and highest tertiles of eGFR variability, respectively. Patients in the highest tertile were at a significantly higher risk for CV events (hazard ratio 1.90; 95{\%} confidence interval 1.03–3.71) than those in the lowest tertile. However, there was no association between eGFR variability and renal endpoints. Conclusions: Variability in eGFR can predict CV outcomes among patients with CKD.",
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T1 - Visit-to-visit variability in estimated glomerular filtration rate predicts hospitalization and death due to cardiovascular events

AU - Suzuki, Akira

AU - Obi, Yoshitsugu

AU - Hayashi, Terumasa

AU - Kotani, Naoto

AU - Uemura, Yukari

AU - Imai, Enyu

AU - Makino, Hirofumi

AU - Hishida, Akira

PY - 2019/1/1

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N2 - Background: Greater variability in estimated glomerular filtration rate (eGFR) is associated with mortality in patients with chronic kidney disease (CKD). However, the association between eGFR variability and cardiovascular (CV) mortality and/or end-stage kidney disease (ESKD) in the CKD population is not very clear. This study aimed to clarify whether such an association exists. Methods: We analyzed a final cohort of 2869 eligible Asian patients with CKD. Patients were stratified into three groups according to eGFR variability during the first year and were followed-up for a median of 3.15 years. Primary CV composite endpoints were hospitalization or death due to CV events, and renal composite endpoints were doubling of serum creatinine levels or ESKD. Multivariate Cox hazard models adjusted for classical risk factors and eGFR slope were used to examine the CV and renal risk associated with eGFR variability. Results: CV endpoints were observed in 14 (2.89%), 25 (5.69%), and 41 (10.79%) patients and renal endpoints were observed in 165 (27.6%), 235 (39.0%), and 298 patients (50.9%) in the lowest, intermediate, and highest tertiles of eGFR variability, respectively. Patients in the highest tertile were at a significantly higher risk for CV events (hazard ratio 1.90; 95% confidence interval 1.03–3.71) than those in the lowest tertile. However, there was no association between eGFR variability and renal endpoints. Conclusions: Variability in eGFR can predict CV outcomes among patients with CKD.

AB - Background: Greater variability in estimated glomerular filtration rate (eGFR) is associated with mortality in patients with chronic kidney disease (CKD). However, the association between eGFR variability and cardiovascular (CV) mortality and/or end-stage kidney disease (ESKD) in the CKD population is not very clear. This study aimed to clarify whether such an association exists. Methods: We analyzed a final cohort of 2869 eligible Asian patients with CKD. Patients were stratified into three groups according to eGFR variability during the first year and were followed-up for a median of 3.15 years. Primary CV composite endpoints were hospitalization or death due to CV events, and renal composite endpoints were doubling of serum creatinine levels or ESKD. Multivariate Cox hazard models adjusted for classical risk factors and eGFR slope were used to examine the CV and renal risk associated with eGFR variability. Results: CV endpoints were observed in 14 (2.89%), 25 (5.69%), and 41 (10.79%) patients and renal endpoints were observed in 165 (27.6%), 235 (39.0%), and 298 patients (50.9%) in the lowest, intermediate, and highest tertiles of eGFR variability, respectively. Patients in the highest tertile were at a significantly higher risk for CV events (hazard ratio 1.90; 95% confidence interval 1.03–3.71) than those in the lowest tertile. However, there was no association between eGFR variability and renal endpoints. Conclusions: Variability in eGFR can predict CV outcomes among patients with CKD.

KW - Cardiovascular mortality

KW - Chronic kidney disease

KW - End-stage kidney disease

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