For patients with chronic kidney disease (CKD), multidisciplinary education can play a role in prevention of disease progression and development of end-stage renal disease (ESRD). Researchers in Japan conducted a study to examine the relationship between estimated glomerular filtration rate (eGFR) slopes before and after CKD education and disease progression.
The retrospective cohort study included 617 patients who underwent in-hospital CKD education at the Nara Prefecture General Medical Center, Nara, Nara, Japan, between January 2013 and December 2016. Following exclusion for the presence of acute kidney injury, urologic malignancies, or collagen disease, the final analysis included 194 patients.
The researchers calculated two eGFR slopes before and after the education intervention with three eGFR levels measured at 3 months to 1 year prior to the intervention, at baseline, and at least 1 year after the intervention. The slope categories were divided according to median levels of two eGFR slopes before and after the education intervention. Slope categories were defined as slow-slow, fast-slow, slow-fast, and fast-fast eGFR decliner. The study outcomes of interest were ESRD and eGFR decline of ≥30%. The reference group was the group with fast-slow eGFR declines.
Median age of the final cohort was 68 years and 67% (n=130) were male. At baseline, median eGFR was 33 mL/min/1.73 m2 (range, 21-48 mL/min/1.73 m2). Median follow-up was 35 months. During follow-up, 53 participants experienced a renal event. In crude Kaplan-Meier analysis, there was a significant association of slow-fast and fast-fast eGFR declines and renal events (P<0.001).
Results of adjusted Cox hazards analyses found hazard ratios for outcomes were 1.72 (95% CI, 0.38-8.8) for slow-slow eGFR decliners, 5.15 (95% CI, 1.72-22.2) for slow-fast eGFR decliners, and 7.27 (95% CI, 2.53-30.7) for fast-fast eGFR decliners.
The researchers said, “Improvement from fast to slow eGFR decline via CKD education was significantly associated with better renal prognosis. However, CKD patients with rapid eGFR decline of –2.5 or more mL/min/1.73 m2 after the education intervention have poor renal outcomes.”
Source: Uemura T, Matsui M, Kokubu M, Tsuruya K. Association of eGFR slopes before and after CKD education with renal prognosis. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2019 (Abstract FR-PO324), November 8, 2019, Washington, DC.