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Abstract
Objectives To examine if the estimated glomerular filtration rate (eGFR) slope over a 5-year period is related to incident cardiovascular (CV) events in the following 5 years.
Design Retrospective cohort study.
Setting Primary care.
Participants All patients aged ≥50 years with at least four eGFR measurements between 01 January 2006 and 31 December 2010 were included in the study.
Outcome measures During the follow-up period (01 January 2011 until 31 December 2015), CV events (acute myocardial infarction, stroke (cerebrovascular accident (CVA)/transient ischemic attack (TIA)), peripheral arterial disease and acute heart failure) were identified.
Methods The slope was calculated by the least square method (in mL/min/year). The following slope categories were considered: (−1 to 1), (−3 to −1) (−5 to −3), ≤−5, (1 to 3), (3 to 5) and ≥5.00 mL/min/year. Cox proportional hazards model was used to assess the association between eGFR slope and incidence of CV events. Survival probability from CV events was estimated per slope category.
Results 19 567 patients had at least four eGFR measurements, of whom 52% was female. 12% of the ≤−5 slope category developed a new CV event in comparison to 7.8% of the reference group and 5.4% of the ≥5 slope category. Survival rates were worst in those with a slope ≤−5. Patients with a slope of (−5 to −3) and ≤−5 had an adjusted HR of 1.37 and 1.55, respectively. Most patients with a slope <−3 mL/min had an eGFR still >60 mL/min.
Conclusions Negative eGFR slopes of at least 3 mL/min/year give irrespectively of the eGFR itself a higher risk of CV events compared with patient groups with stable or improved kidney function. So the eGFR slope identifies an easy to define group of patients with a high risk for developing CV events.
- cardiovascular events
- eGFR slope
- risk prediction
- general practice
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Footnotes
Contributors GVP, NO and MVDA performed the analyses and wrote the manuscript. PM extracted the data. GVP, MVDA, PM, BV and GG were responsible for the study concept, design and acquisition of participants and data. All authors participated in the interpretation of the data.
Funding Intego is funded on a regular basis by the Flemish Government (Ministry of Health and Welfare). This work would not have been possible without the collaboration of all general practitioners in the Intego network. We hereby state the independence of researchers from funders.
Competing interests None declared.
Patient consent Not required.
Ethics approval Intego procedures were approved by the ethical review board of the Medical School of the Catholic University of Leuven (No ML 1723) and by the Belgian Privacy Commission (no SCSZG/13/079).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.