Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression
Abstract Background Patients with rapidly declining renal function face the dual threat of end-stage renal disease (ESRD) and mortality prior to ESRD. What is less well characterised is whether the pattern of the renal trajectory, linear or non-linear, unmasks subgroups of rapidly progressing patien...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-021-02282-5 |
| _version_ | 1828926769744314368 |
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| author | Ibrahim Ali Rajkumar Chinnadurai Sara T. Ibrahim Philip A. Kalra |
| author_facet | Ibrahim Ali Rajkumar Chinnadurai Sara T. Ibrahim Philip A. Kalra |
| author_sort | Ibrahim Ali |
| collection | DOAJ |
| description | Abstract Background Patients with rapidly declining renal function face the dual threat of end-stage renal disease (ESRD) and mortality prior to ESRD. What is less well characterised is whether the pattern of the renal trajectory, linear or non-linear, unmasks subgroups of rapidly progressing patients that face adverse outcomes in a differential manner. Methods An individual eGFR slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for each patient in the Salford Kidney Study from 2002 to 2018 who had at least 2 years follow-up, ≥4 eGFR values and baseline eGFR 15 to < 60 ml/min/1.73m2. Rapid progression was defined as an annual eGFR slope of ≤ − 3 ml/min/1.73m2/yr and patients were categorised as linear or non-linear progressors based on the nature of their eGFR-time graphs. A Fine-Gray competing risk hazard model was used to determine factors associated with progression to ESRD and with mortality prior to ESRD. Cumulative incidence function curves highlighted differences in outcomes between linear and non-linear patients. Results There were 211 rapidly deteriorating patients with linear eGFR trajectories and 61 rapid non-linear patients in the study cohort. Factors associated with ESRD included younger age, male gender, lower baseline eGFR and higher serum phosphate, whilst older age, history of myocardial infarction and anaemia predicted mortality prior to ESRD. Over a median follow-up of 3.7 years, linear progressors reached ESRD sooner whilst those with non-linear progression faced significantly higher rates of mortality prior to ESRD. Conclusions Patients with rapid eGFR decline have high rates of adverse outcomes that are differentially expressed in those progressing linearly and non-linearly as a result of differing phenotypic profiles. Consequently, addressing individual risk factor profiles is important to deliver optimal personalised patient care. |
| first_indexed | 2024-12-13T23:40:02Z |
| format | Article |
| id | doaj.art-7e9a67eb559b44559f4004b2142d38ca |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-13T23:40:02Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-7e9a67eb559b44559f4004b2142d38ca2022-12-21T23:27:12ZengBMCBMC Nephrology1471-23692021-03-0122111010.1186/s12882-021-02282-5Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progressionIbrahim Ali0Rajkumar Chinnadurai1Sara T. Ibrahim2Philip A. Kalra3Department of Renal Medicine, Salford Royal NHS Foundation TrustDepartment of Renal Medicine, Salford Royal NHS Foundation TrustDepartment of Internal Medicine and Nephrology, Faculty of Medicine, Alexandria UniversityDepartment of Renal Medicine, Salford Royal NHS Foundation TrustAbstract Background Patients with rapidly declining renal function face the dual threat of end-stage renal disease (ESRD) and mortality prior to ESRD. What is less well characterised is whether the pattern of the renal trajectory, linear or non-linear, unmasks subgroups of rapidly progressing patients that face adverse outcomes in a differential manner. Methods An individual eGFR slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for each patient in the Salford Kidney Study from 2002 to 2018 who had at least 2 years follow-up, ≥4 eGFR values and baseline eGFR 15 to < 60 ml/min/1.73m2. Rapid progression was defined as an annual eGFR slope of ≤ − 3 ml/min/1.73m2/yr and patients were categorised as linear or non-linear progressors based on the nature of their eGFR-time graphs. A Fine-Gray competing risk hazard model was used to determine factors associated with progression to ESRD and with mortality prior to ESRD. Cumulative incidence function curves highlighted differences in outcomes between linear and non-linear patients. Results There were 211 rapidly deteriorating patients with linear eGFR trajectories and 61 rapid non-linear patients in the study cohort. Factors associated with ESRD included younger age, male gender, lower baseline eGFR and higher serum phosphate, whilst older age, history of myocardial infarction and anaemia predicted mortality prior to ESRD. Over a median follow-up of 3.7 years, linear progressors reached ESRD sooner whilst those with non-linear progression faced significantly higher rates of mortality prior to ESRD. Conclusions Patients with rapid eGFR decline have high rates of adverse outcomes that are differentially expressed in those progressing linearly and non-linearly as a result of differing phenotypic profiles. Consequently, addressing individual risk factor profiles is important to deliver optimal personalised patient care.https://doi.org/10.1186/s12882-021-02282-5Chronic kidney diseaseCKDLinearNon-linearProgressionEnd-stage renal disease |
| spellingShingle | Ibrahim Ali Rajkumar Chinnadurai Sara T. Ibrahim Philip A. Kalra Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression BMC Nephrology Chronic kidney disease CKD Linear Non-linear Progression End-stage renal disease |
| title | Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression |
| title_full | Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression |
| title_fullStr | Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression |
| title_full_unstemmed | Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression |
| title_short | Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression |
| title_sort | adverse outcomes associated with rapid linear and non linear patterns of chronic kidney disease progression |
| topic | Chronic kidney disease CKD Linear Non-linear Progression End-stage renal disease |
| url | https://doi.org/10.1186/s12882-021-02282-5 |
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