American Journal of Kidney Diseases

Longitudinal Progression Trajectory of GFR Among Patients With CKD

Published:January 27, 2012DOI:


      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.


      Longitudinal GFR estimates from creatinine-based equations.


      Patient demographic and clinical features.


      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.


      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.


      Clinical trial population; absence of direct GFR measurements.


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mitch W.
        • Walser M.
        • Buffington G.
        • Lemann J.
        A simple method of estimating progression of chronic renal failure.
        Lancet. 1976; 2: 1326-1328
        • Levey A.
        • Perrone R.
        • Madias N.
        Serum creatinine and renal function.
        Ann Rev Med. 1988; 39: 465-490
        • Hunsicker L.G.
        • Adler S.
        • Caggiula A.
        • et al.
        Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study.
        Kidney Int. 1997; 51: 1908-1919
        • Klahr S.
        • Levey A.S.
        • Beck G.J.
        • et al.
        The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease.
        N Engl J Med. 1994; 330: 877-884
        • Lewis E.J.
        • Hunsicker L.G.
        • Clarke W.R.
        • et al.
        Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.
        N Engl J Med. 2001; 345: 851-860
        • Brenner B.M.
        • Cooper M.E.
        • de Zeeuw D.
        • et al.
        Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.
        N Engl J Med. 2001; 345: 861-869
        • Gassman J.J.
        • Greene T.
        • Wright Jr, J.T.
        • et al.
        Design and statistical aspects of the African American Study of Kidney Disease and Hypertension (AASK).
        J Am Soc Nephrol. 2003; 14: S154-S165
        • Appel L.J.
        • Middleton J.
        • Miller III, E.R.
        • et al.
        The rationale and design of the AASK cohort study.
        J Am Soc Nephrol. 2003; 14: S166-S172
        • Lewis J.
        • Agodoa L.
        • Cheek D.
        • et al.
        Comparison of cross-sectional renal function measurements in African Americans with hypertensive nephrosclerosis and of primary formulas to estimate glomerular filtration rate.
        Am J Kidney Dis. 2001; 38: 744-753
        • Crainiceanu C.M.
        • Ruppert D.
        • Wand M.P.
        Bayesian analysis for penalized spline regression using WinBUGS.
        J Stat Software. 2005; 14
        • Wright Jr, J.T.
        • 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; 288: 2421-2431
        • Lindeman R.D.
        • Tobin J.
        • Shock N.W.
        Longitudinal studies on the rate of decline in renal function with age.
        J Am Geriatr Soc. 1985; 33: 278-285
        • National Kidney Foundation
        K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: S1-S266
        • R Development Core Team
        R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria2011
        • Norris K.C.
        • Greene T.
        • Kopple J.
        • et al.
        Baseline predictors of renal disease progression in the African American Study of Hypertension and Kidney Disease.
        J Am Soc Nephrol. 2006; 17: 2928-2936
      1. Hu B, Gadegbeku C, Lipkowitz MS, et al. Kidney function can improve in patients with hypertensive chronic kidney disease: results from the African American Study of Kidney Disease and Hypertension (AASK). J Am Soc Nephrol. In press.