One‐year estimated glomerular filtration rate decline as a risk factor of cardiovascular and renal end‐points in high‐risk Japanese patients

Abstract

Abstract Aims/Introduction As estimated glomerular filtration rate (eGFR) progression might correlate with cardiovascular prognosis, the correlation between 1‐year decline in eGFR and cardiovascular incidences and renal outcome was investigated. Materials and Methods The 1‐year percentage decline in eGFR at the first observation year was calculated in a cohort of the standard versus intEnsive statin therapy for hypercholesteroleMic Patients with diAbetic retinopaTHY (EMPATHY) trial participants. The primary end‐point was the composite cardiovascular end‐point including the renal end‐point. The associations between the incidence of each end‐point and clinical markers were analyzed using the Cox proportional hazards regression model. Results A total of 4,461 patients were analyzed. The mean observation period was 765.3 ± 363.1 days. The best cut‐off value of 1‐year eGFR decline was 0.099 in the first year for renal end‐point prediction by receiver operating characteristic curve analysis. The area under the curve of the model including the 1‐year eGFR decline of the first year was significantly larger than the model without it (0.943, 95% confidence interval 0.915–0.971 to 0.967, 95% confidence interval 0.950–0.983, P = 0.019). Primary end‐point incidences and the renal end‐point were much higher in rapid eGFR decliners compared with non‐decliners (P < 0.0001). The cardiovascular end‐point incidence, except for the renal end‐point, was not different between the groups. According to Cox regression analysis, 1‐year eGFR decline during the first year was a significant risk factor for the end‐points, including the renal end‐point, independent of albuminuria and eGFR at baseline. Conclusions The 1‐year eGFR decline rate provided useful information for cardiovascular end‐point predictions, including the renal end‐point, in addition to the conventional risk factors.

Keywords

• Diabetic kidney disease
• Estimated glomerular filtration rate
• Risk factors