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Fast GFR decline and progression to CKD among primary care patients with preserved GFR

  • Nephrology - Original Paper
  • Published:
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Abstract

Background

Fast glomerular filtration rate (GFR) decline is associated with adverse outcomes, but the associated risk factors among patients without chronic kidney disease (CKD) are not well defined.

Methods

From a primary care registry of 37,796, we identified 2219 (6%) adults with at least three estimated (e)GFR values and a baseline eGFR between 60 and 119 ml/min/1.73 m2 during an observation period of 8 years. We defined fast GFR decline as > 5 ml/min/1.73 m2 per year. The outcome measure was incident CKD (eGFR < 60 ml/min/1.73 m2). Clinical and demographic characteristics were compared using Chi-square and independent-samples t tests.

Results

Older age, African-American race, unmarried status, hypertension and type 2 diabetes were more common in both fast decliners and those who developed incident CKD (p < 0.0001 to < 0.05). Lower neighborhood socioeconomic status, current smoking and baseline eGFR 90–119 ml/min/1.73 m2 were associated with fast decline (p < 0.01), while baseline eGFR 60–74 ml/min/1.73 m2 with incident CKD (p < 0.05). In multivariate regression models, among fast decliners with mildly reduced baseline eGFR (60–89 ml/min/1.73 m2), older age was significantly associated with incident CKD [odds ratio (OR) 1.04; 95% CI 1.01–1.08], and among those with normal baseline eGFR (≥ 90–119 ml/min/1.73 m2), type 2 diabetes was significantly associated with incident CKD (OR 3.83; 95% CI 1.35–10.89).

Conclusions

Among primary care patients without CKD, GFR is checked infrequently. We have identified patients at high risk of progressive CKD, in whom we suggest a closer monitoring of renal function.

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Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA

    Farrukh M. Koraishy & Michael Rauchman

  2. Nephrology Section, Medicine Service, VA St. Louis Health Care System, John Cochran Division, 111B-JC, 915 North Grand, St. Louis, MO, 63106, USA

    Farrukh M. Koraishy & Michael Rauchman

  3. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA

    Denise Hooks-Anderson, Joanne Salas & Jeffrey F. Scherrer

Authors
  1. Farrukh M. Koraishy
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  2. Denise Hooks-Anderson
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  3. Joanne Salas
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  4. Michael Rauchman
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  5. Jeffrey F. Scherrer
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Corresponding author

Correspondence to Farrukh M. Koraishy.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

The creation of this retrospective cohort and its use for primary care research were approved by the SLU Institutional Review Board. Informed consent was waived due to the observational nature of the study, and no PHI was used.

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Koraishy, F.M., Hooks-Anderson, D., Salas, J. et al. Fast GFR decline and progression to CKD among primary care patients with preserved GFR. Int Urol Nephrol 50, 501–508 (2018). https://doi.org/10.1007/s11255-018-1805-1

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  • DOI: https://doi.org/10.1007/s11255-018-1805-1

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