The Next-Generation CKD Heat Map: Hyperfiltration and eGFR Slope in the Cardiorenal Continuum

Figures

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  Figure 1. High eGFR unmasks a hidden high-risk phenotype (schematic). Individuals with very high eGFR (≥ 105 ml/min per 1.73 m2)—particularly when accompanied by albuminuria—experience all-cause and cardiovascular mortality exceeding that of moderate CKD. This pattern, preserved in Figure 5 of the KDIGO 2024 CKD guideline, suggests that hyperfiltration may reflect cardiorenal overload rather than preserved renal function and underscores potential limitations of purely static risk-staging frameworks. The heat-map structure is adapted from Figure 5 of the KDIGO 2024 CKD guideline. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; eGFRcr, creatinine-based eGFR,

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  Figure 2. (a) Hyperfiltration and glomerular hypertrophy shape lifetime eGFR trajectories (schematic). Hyperfiltration initially elevates filtration through increased nephron workload but may shift the lifetime eGFR trajectory downward, resulting in earlier and steeper decline—a conceptual illustration of “early burnout” and filtration instability within the cardiorenal continuum. (b) eGFR slope as a dynamic “11th dimension” of kidney risk (schematic). Both steep decline and paradoxical increase in eGFR slope independently predict kidney failure, major cardiovascular events, and mortality—regardless of baseline eGFR category. Slope reflects filtration instability not captured by static eGFR–albuminuria staging and provides a dynamic marker linking filtration stress to downstream clinical outcomes. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; UACR, urine albumin-to-creatinine ratio.