Longitudinal progression trajectory of GFR among patients with CKD
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 D...
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| Veröffentlicht in: | American journal of kidney diseases Jg. 59; H. 4; S. 504 |
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| Hauptverfasser: | , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
01.04.2012
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| ISSN: | 1523-6838, 1523-6838 |
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| Abstract | 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).
Longitudinal observational study.
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. |
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| AbstractList | 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).BACKGROUNDThe 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).Longitudinal observational study.STUDY DESIGNLongitudinal observational study.846 AASK patients with at least 3 years of follow-up and 8 GFR estimates.SETTING & PARTICIPANTS846 AASK patients with at least 3 years of follow-up and 8 GFR estimates.Longitudinal GFR estimates from creatinine-based equations.MEASUREMENTSLongitudinal GFR estimates from creatinine-based equations.Patient demographic and clinical features.PREDICTORSPatient 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.OUTCOMESProbability 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.RESULTS352 (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.LIMITATIONSClinical 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.CONCLUSIONSIn 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. 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). Longitudinal observational study. 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. |
| Author | Greene, Tom H Li, Liang Lipkowitz, Michael S Lewis, Julia Wright, Jr, Jackson T Appel, Lawrence J Wang, Xuelei Astor, Brad C Hu, Bo Toto, Robert D |
| Author_xml | – sequence: 1 givenname: Liang surname: Li fullname: Li, Liang email: lil2@ccf.org organization: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44139, USA. lil2@ccf.org – sequence: 2 givenname: Brad C surname: Astor fullname: Astor, Brad C – sequence: 3 givenname: Julia surname: Lewis fullname: Lewis, Julia – sequence: 4 givenname: Bo surname: Hu fullname: Hu, Bo – sequence: 5 givenname: Lawrence J surname: Appel fullname: Appel, Lawrence J – sequence: 6 givenname: Michael S surname: Lipkowitz fullname: Lipkowitz, Michael S – sequence: 7 givenname: Robert D surname: Toto fullname: Toto, Robert D – sequence: 8 givenname: Xuelei surname: Wang fullname: Wang, Xuelei – sequence: 9 givenname: Jackson T surname: Wright, Jr fullname: Wright, Jr, Jackson T – sequence: 10 givenname: Tom H surname: Greene fullname: Greene, Tom H |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22284441$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Bayes Theorem Black or African American - ethnology Chronic Disease Cohort Studies Creatinine - urine Disease Progression Female Follow-Up Studies Glomerular Filtration Rate - physiology Humans Kidney Diseases - ethnology Kidney Diseases - physiopathology Kidney Diseases - urine Longitudinal Studies Male Middle Aged Proteinuria - ethnology Proteinuria - physiopathology Time Factors |
| Title | Longitudinal progression trajectory of GFR among patients with CKD |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/22284441 https://www.proquest.com/docview/948907136 |
| Volume | 59 |
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