Combining eGFR and albuminuria for CKD classification reduced the required referral population from 4.7% to 1.4% while maintaining similar detection of ESRD progression (65.6% vs 69.4%).
Cohort (n=65,589)
Does combining estimated GFR and albuminuria improve the prediction of progression to end-stage renal disease in the general adult population?
Combining eGFR and urinary albumin quantification significantly improves the prediction of ESRD progression compared to eGFR alone, allowing for more accurate and efficient specialist referral.
Absolute Event Rate: 65.6% vs 69.4%
p-value: p=<0.001
Despite the high prevalence of chronic kidney disease (CKD), relatively few individuals with CKD progress to ESRD. A better understanding of the risk factors for progression could improve the classification system of CKD and strategies for screening. We analyzed data from 65,589 adults who participated in the Nord-Trøndelag Health (HUNT 2) Study (1995 to 1997) and found 124 patients who progressed to ESRD after 10.3 yr of follow-up. In multivariable survival analysis, estimated GFR (eGFR) and albuminuria were independently and strongly associated with progression to ESRD: Hazard ratios for eGFR 45 to 59, 30 to 44, and 15 to 29 ml/min per 1.73 m(2) were 6.7, 18.8, and 65.7, respectively (P < 0.001 for all), and for micro- and macroalbuminuria were 13.0 and 47.2 (P < 0.001 for both). Hypertension, diabetes, male gender, smoking, depression, obesity, cardiovascular disease, dyslipidemia, physical activity and education did not add predictive information. Time-dependent receiver operating characteristic analyses showed that considering both the urinary albumin/creatinine ratio and eGFR substantially improved diagnostic accuracy. Referral based on current stages 3 to 4 CKD (eGFR 15 to 59 ml/min per 1.73 m(2)) would include 4.7% of the general population and identify 69.4% of all individuals progressing to ESRD. Referral based on our classification system would include 1.4% of the general population without losing predictive power (i.e., it would detect 65.6% of all individuals progressing to ESRD). In conclusion, all levels of reduced eGFR should be complemented by quantification of urinary albumin to predict optimally progression to ESRD.
Hallan et al. (2009) conducted a cohort in Chronic kidney disease (n=65,589). Combined eGFR and albuminuria classification vs. eGFR alone (current stages 3 to 4 CKD) was evaluated on Progression to ESRD (p=<0.001). Combining eGFR and albuminuria for CKD classification reduced the required referral population from 4.7% to 1.4% while maintaining similar detection of ESRD progression (65.6% vs 69.4%).