Higher EGFR variability predicts higher risk of death, dementia, disability, and CVD events | Jobs Reply

December 15, 2022

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Greater eGFR variability predicts increased risk of death, dementia, disability, and CVD events among healthy older adults, according to published data. Renal Medicine.

Furthermore, these associations persist regardless of chronic kidney disease status.

Infographic showing the correlation of high eGFR variability

Data from Fravel MA, et al. Kidney Med. 2022; doi:10.1016/j.xkme.2022.100583.

“The use of isolated eGFR measures to establish prognosis in older adults is problematic because eGFR declines even in healthy aging. In patients with multiple comorbidities, studies have associated eGFR variability with an increased risk of poor health outcomes. The prognostic significance of eGFR variability in healthy, older adults is unclear. Michelle A. Fravel, PharmD, of the Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, and colleagues.

In a post-hoc analysis of 12,549 participants in the Aspirin to Reduce Events in the Elderly (ASPREE) trial, researchers examined the relationship between eGFR variability and CVD events without dementia or disability. No participants were diagnosed with dementia, major physical disabilities, previous CVD, or any other major life-limiting illness.

In the ASPREE trial, participants consumed 100 mg of aspirin daily between 2010 and 2017. Additionally, eGFR was measured at baseline, one and two annual visits, and then treated as a continuous variable throughout the study. Participants were categorized into tertiles of eGFR, with the lowest tertiles included in the analysis.

A total of 838 participants died, developed dementia, or developed a permanent physical disability after a median follow-up of 2.7 years, and 379 participants experienced a CVD event.

Compared with the lowest tertile of eGFR variability, the researchers found a 35% increased risk of death, dementia, or physical disability, and a 37% increased risk of CVD events in the highest tertile, after adjusting for covariates. Furthermore, these correlations were present in participants with and without CKD at baseline.

“In the current analysis, healthy older adults with greater variability in eGFR were less likely to survive without dementia or permanent physical disability and less likely to experience a CVD event during follow-up than those with less variability in eGFR. These associations were independent of baseline kidney function and consistent were in different analytical approaches.The risk of death or dementia or physical disability increased by 11% and the risk of cardiovascular events increased by 9% for each 3 ml/min/1.73 m.2 standard deviation difference in eGFR,” wrote Fravel and colleagues. “Our findings suggest that it may be important to monitor variation in eGFR over time in healthy older adults as a novel predictor of risk for future poor health outcomes.”

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