Longitudinal Progression Trajectory of GFR Among Patients With CKD

Li, Liang; Astor, Brad C.; Lewis, Julia; Hu, Bo; Appel, Lawrence J.; Lipkowitz, Michael S.; Toto, Robert D.; Wang, Xuelei; Wright, Jackson T.; Greene, Tom H.

doi:10.1053/j.ajkd.2011.12.009

« Previous Next »American Journal of Kidney Diseases
Volume 59, Issue 4 , Pages 504-512, April 2012

Longitudinal Progression Trajectory of GFR Among Patients With CKD

Liang Li, PhD
- Cleveland Clinic, Cleveland, OH
- Address correspondence to Liang Li, PhD, Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, JJN3, Cleveland, OH 44139
Brad C. Astor, PhD
- University of Wisconsin-Madison, Madison, WI
Julia Lewis, MD
- Vanderbilt University, Nashville, TN
Bo Hu, PhD
- Cleveland Clinic, Cleveland, OH
Lawrence J. Appel, MD, MPH
- Johns Hopkins University, Baltimore, MD
Michael S. Lipkowitz, MD
- Georgetown University, Washington, DC
Robert D. Toto, MD
- University of Texas Southwestern Medical Center, Dallas, TX
Xuelei Wang, MS
- Case Western Reserve University, Cleveland, OH
Jackson T. Wright Jr, MD, PhD
- Case Western Reserve University, Cleveland, OH
Tom H. Greene, PhD
- University of Utah, Salt Lake City, UT

Received 20 July 2011; accepted 9 December 2011. published online 27 January 2012.

Background

The traditional paradigm of glomerular filtration rate (GFR) progression in patients with chronic kidney disease (CKD) is a steady nearly linear decline over time. We describe individual GFR progression trajectories over 12 years of follow-up in participants in the African American Study of Kidney Disease and Hypertension (AASK).

Study Design

Longitudinal observational study.

Setting & Participants

846 AASK patients with at least 3 years of follow-up and 8 GFR estimates.

Measurements

Longitudinal GFR estimates from creatinine-based equations.

Predictors

Patient demographic and clinical features.

Outcomes

Probability of a nonlinear trajectory and probability of a period of nonprogression calculated for each patient from a Bayesian model of individual estimated GFR (eGFR) trajectories.

Results

352 (41.6%) patients showed a >0.9 probability of having either a nonlinear trajectory or a prolonged nonprogression period; in 559 (66.1%), the probability was >0.5. Baseline eGFR >40 mL/min/1.73 m² and urine protein-creatinine ratio <0.22 g/g were associated with a higher likelihood of a nonprogression period. 74 patients (8.7%) had both a substantial period of stable or increasing eGFR and a substantial period of rapid eGFR decrease.

Limitations

Clinical trial population; absence of direct GFR measurements.

Conclusions

In contrast to the traditional paradigm of steady GFR progression over time, many patients with CKD have a nonlinear GFR trajectory or a prolonged period of nonprogression. These findings highlight the possibility that stable kidney disease progression can accelerate and, conversely, provide hope that CKD need not be relentlessly progressive. These results should encourage researchers to identify time-dependent factors associated with periods of nonprogression and other desirable trajectories.

Index Words: Chronic kidney disease , estimated glomerular filtration rate , nonlinear progression , longitudinal cohort study , African American , slope