Longitudinal change in estimated GFR among CKD patients: A 10-year follow-up study of an integrated kidney disease care program in Taiwan

Tsai, Chin-Ho; Ting, I-Wen; Yeh, Hung‐Chieh; Kuo, Chin‐Chi

doi:10.1371/journal.pone.0173843

Cited by 50 publications

(40 citation statements)

References 38 publications

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“…These factors may explain the fact that this group could maintain their cardiovascular and muscular function and thereby their aerobic ExCap. The mean decline in GFR over time was comparable to or a little lower than values reported in other studies [12,34,35]. Interestingly, Jones et al reported that GFR decline slowed signi cantly following referral to a nephrology clinic, indicating that interventions to slow progression of CKD are important and bene cial.…”

Section: Discussionsupporting

confidence: 68%

Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: A longitudinal study

Wallin

Jansson

Wallquist

et al. 2020

Preprint

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Background: Aerobic exercise capacity is reduced in non-dialysis chronic kidney disease (CKD), but little is known about the magnitude of changes in exercise capacity over time. Our main hypothesis was that aerobic ExCap would decline over 5 years in individuals with mild-to-moderate CKD along with a decline in renal function. A secondary hypothesis was that such a decline in ExCap would be associated with a decline in muscle strength, cardiovascular function and physical activity. Methods: We performed a 5-year-prospective study on individuals with mild-to-moderate CKD, who were closely monitored at a nephrology clinic. Fiftytwo individuals with CKD stage 2–3 and 54 age- and sex-matched healthy controls were included. Peak workload was assessed through a maximal cycle exercise test. Muscle strength and lean body mass, cardiac function, vascular stiffness, self-reported physical activity level, renal function and haemoglobin level were evaluated. Tests were repeated after 5 years. Statistical analysis of longitudinal data was performed using linear mixed models.Results: Exercise capacity did not change significantly over time in either the CKD group or controls, although the absolute workloads were significantly lower in the CKD group. Only in a CKD subgroup reporting low physical activity at baseline, exercise capacity declined. Renal function decreased in both groups, with a faster decline in CKD (p = 0.05 between groups). Peak heart rate, haemoglobin level, handgrip strength, lean body mass and cardiovascular function did not decrease significantly over time in CKD individuals. Conclusions: On a group level, aerobic exercise capacity and peak heart rate were maintained over 5 years in patients with well-controlled mild-to-moderate CKD, despite a slight reduction in glomerular filtration rate, mirroring the lack of progression of cardiovascular and muscular dysfunction in this group. In patients with mild-to-moderate CKD, physical activity level at baseline seems to have a predictive value for exercise capacity at follow-up.

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Section: Discussionsupporting

confidence: 68%

Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: A longitudinal study

Wallin

Jansson

Wallquist

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In 2007, the program used a multidisciplinary approach to focus on CKD stages 3b to 5 (24,25). China Medical University Hospital (CMUH), a tertiary medical center in central Taiwan, joined the program in 2003 and prospectively enrolled consecutive patients with CKD who were willing to participate (25,26). CKD diagnosis was based on the criteria of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for CKD (25,27).…”

Section: Study Populationmentioning

confidence: 99%

Longitudinal lipid trends and adverse outcomes in patients with CKD: a 13-year observational cohort study

Tsai

Huang

Chiang

et al. 2019

Journal of Lipid Research

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Studies on the effects of longitudinal lipid trajectories on end-stage renal disease (ESRD) development and deaths among patients with chronic kidney disease (CKD) are limited. We conducted a registry-based prospective study using data from a 13-year multidisciplinary pre-ESRD care program. The final study population comprised 4,647 patients with CKD. Using group-based trajectory modeling, we dichotomized longitudinal trajectories of total cholesterol (T-CHO), triglyceride (TG), LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C). Time to ESRD or death was analyzed using multiple Cox regression. At baseline, higher levels of T-CHO and LDL-C were associated with rapid progression to ESRD, whereas only HDL-C was positively associated with all-cause mortality [adjusted hazard ratio (HR), 1.20; 95% CI, 1.06-1.36; P-value, 0.005]. Compared with those with a normal T-CHO trajectory, the fully adjusted HR of patients with a high T-CHO trajectory for ESRD risk was 1.21 (P-value, 0.019). Subgroup analysis showed that a high TG trajectory was associated with a 49% increase in mortality risk in CKD patients without diabetes (P-value for interaction, 0.012). In contrast to what was observed based on baseline HDL-C, patients with a trajectory of frequent hypo-HDL cholesterolemia had higher risk of all-cause mortality (adjusted HR, 1.53; P-value, 0.014). Thus, only T-CHO, both at baseline and over the longitudinal course, demonstrated a significant potential risk of incident ESRD. The inconsistency in the observed directions of association between baseline levels and longitudinal trajectories of HDL-C warrants further research to unveil specific pathogenic mechanisms underlying the HDL-C metabolism in patients with CKD.-

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“…Nevertheless, worsening eGFR has been shown to be associated with decreased survival in SCD . Additionally, a growing body of evidence suggests that the rate of annual GFR decline is predictive of progression to ESRD and death in the general population, and that a rapid rate of decline of approximately ≥3 mL/min/1.73 m 2 /year is a useful surrogate measure of clinically meaningful outcomes …”

Section: Introductionmentioning

confidence: 99%

Clinical and metabolomic risk factors associated with rapid renal function decline in sickle cell disease

Garrett

Soldano

et al. 2018

American J Hematol

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Sickle cell disease (SCD) nephropathy and lower estimated glomerular filtration rate (eGFR) are risk factors for early mortality. Furthermore, rate of eGFR decline predicts progression to end-stage renal disease in many clinical settings. However, factors predicting renal function decline in SCD are poorly documented. Using clinical, laboratory, genetic, and metabolomic data, we evaluated predictors of renal function decline in a longitudinal cohort of 288 adults (mean age 33.0 years). In 193 subjects with 5-year follow-up data, mean rate of eGFR decline was 2.35 mL/min/1.73 m /year, nearly twice that of African American adults overall. Hyperfiltration was prevalent at baseline (61.1%), and 36.8% of subjects experienced rapid eGFR decline (≥3 mL/min/1.73 m /year). Severe Hb genotype; proteinuria; higher platelet and reticulocyte counts, and systolic BP; and lower Hb level and BMI were associated with rapid decline. A risk scoring system was created using these 7 variables and was highly predictive of rapid eGFR decline, with odds of rapid decline increasing 1.635-fold for every point increment (P < 0.0001). Rapid eGFR decline was also associated with higher organ system severity score and peak creatinine. Additionally, two metabolites (asymmetric dimethylarginine and quinolinic acid) were associated with rapid decline. Further investigation into longitudinal SCD nephropathy (SCDN) trajectory, early markers of SCDN, and tools for risk stratification should inform interventional studies targeted to slowing GFR decline and improving SCD outcomes.

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Longitudinal change in estimated GFR among CKD patients: A 10-year follow-up study of an integrated kidney disease care program in Taiwan

Cited by 50 publications

References 38 publications

Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: A longitudinal study

Aerobic exercise capacity is maintained over a 5-year period in mild-to-moderate chronic kidney disease: A longitudinal study

Longitudinal lipid trends and adverse outcomes in patients with CKD: a 13-year observational cohort study

Clinical and metabolomic risk factors associated with rapid renal function decline in sickle cell disease

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