Kidney failure is a serious but rare consequence of progressive chronic kidney disease. A meta-analysis of individual participant-level trial data, across heterogeneous treatments and disease groups, has shown glomerular filtration rate (GFR) slope to be a valid, fit-for-purpose and robust surrogate marker of kidney failure.
This is a preview of subscription content, log in via an institution to check access.
References
Foreman, K. J. et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet 392, 2052–2090 (2018).
Inker, L. A. et al. A meta-analysis of GFR slope as a surrogate endpoint for kidney failure. Nat. Med. https://doi.org/10.1038/s41591-023-02418-0 (2023).
Yu, T. et al. Use of surrogate outcomes in US FDA drug approvals, 2003-2012: a survey. BMJ Open 5, e007960 (2015).
Inker, L. A. et al. GFR slope as a surrogate end point for kidney disease progression in clinical trials: a meta-analysis of treatment effects of randomized controlled trials. J. Am. Soc. Nephrol. 30, 1735–1745 (2019).
Keith, D. S., Nichols, G. A., Gullion, C. M., Brown, J. B. & Smith, D. H. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch. Intern. Med. 164, 659–663 (2004).
Nissen, S. E. & Wolski, K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N. Engl. J. Med. 356, 2457–2471 (2007).
Chute, D. F. et al. Incidence and predictors of CKD and estimated GFR decline in patients receiving immune checkpoint inhibitors. Am. J. Kidney Dis. 79, 134–137 (2022).
Lees, J. S. et al. A systematic review and meta-analysis of the effect of intravitreal VEGF inhibitors on cardiorenal outcomes. Nephrol. Dial. Transplant. 38, 1666–1681 (2023).
Melsom, T. et al. Sex differences in age-related loss of kidney function. J. Am. Soc. Nephrol. 33, 1891–1902 (2022).
Fu, E. L. et al. Accuracy of GFR estimating equations in patients with discordances between creatinine and cystatin C-based estimations. J. Am. Soc. Nephrol. 34, 1241–1251 (2023).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
J.S.L. has received personal lectureship honoraria from Astra Zeneca, Pfizer and Bristol Myers Squibb. P.B.M. reports lecture fees and/or fees for participating advisory boards and trial end point committees from Vifor, GSK, Astra Zeneca, Pharmacomsos, Napp, Astellas and Boehringer Ingelheim, and grants from Boehringer Ingelheim.
Rights and permissions
About this article
Cite this article
Lees, J.S., Mark, P.B. GFR slope as a surrogate marker for future kidney failure. Nat Rev Nephrol 19, 625–626 (2023). https://doi.org/10.1038/s41581-023-00748-3
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41581-023-00748-3
- Springer Nature Limited