eGFR in CSF-flow disorders - a representation of comorbid state or an element of the underlying pathophysiology? (original) (raw)
Related papers
Improvement in eGFR in patients with chronic kidney disease attending a nephrology clinic
International Urology and Nephrology, 2008
Background The adverse effects arising from late referral to a nephrologist of patients with chronic kidney disease (CKD) are well known. Retrospectively we examined the initial characteristics of patients referred in various stages of CKD to our nephrology division and tried to identify potential baseline factors associated with subsequent changes in estimated glomerular filtration rate (eGFR). Patients and methods Between September 1997 and June 2006 1,443 patients (909 male, 534 female) with CKD, with eGFRs ranging from 15 to 89 ml/min, were referred to our nephrology division and categorized using the National Kidney Foundation classification for CKD based on eGFR. The slope of eGFR change (ml/min−1/1.73/m2−1/year−1) was determined by linear regression analysis and the patients were divided into five groups: (1) significantly progressive slope (deterioration) (more negative than −5 ml/min/year); (2) mildly progressive slope (>−5 to ≤−1); (3) stable slope (>−1 to ≤+1); (4) mildly improved slope (>+1 to ≤+5), and (5) significantly improved slope (≥+5). Results At the first nephrology referral, 5.8% of the patients were on CKD stage 2 (eGFR: 90–60 ml/m), 46.7% on CKD stage 3 (eGFR: 59–30 ml/m), and 47.5% on CKD stage 4 (eGFR: 29–15 ml/m) CKD. Significantly improved slope was detected in 48.2% of CKD stage 2 patients, 29.3% of CKD stage 3 patients, and only 14.7% of CKD stage 4 patients (P Conclusion Referral to a nephrology clinic can lead not only to arrest of progression of CKD but also to regression/improvement. Early referral is a positive predictive factor for improvement in eGFR, which emphasizes the importance of such referral. The previously held idea that, once established, CKD progresses invariably is not valid anymore.
Renal Function Trajectories in Patients with Prior Improved eGFR Slopes and Risk of Death
PloS one, 2016
Multiple prior studies demonstrated that patients with early Chronic Kidney Disease (CKD) and positive estimated Glomerular Filtration Rate (eGFR) slopes experience increased risk of death. We sought to characterize patients with positive eGFR slopes, examine the renal function trajectory that follows the time period where positive slope is observed, and examine the association between different trajectories and risk of death. We built a cohort of 204,132 United States veterans with early CKD stage 3; eGFR slopes were defined based on Bayesian mixed-effects models using outpatient eGFR measurements between October 1999 and September 2004; to build renal function trajectories, patients were followed longitudinally thereafter (from October 2004) until September 2013. There were 41,410 (20.29%) patients with positive eGFR slope and they exhibited increased risk of death compared to patients with stable eGFR slope (HR = 1.33, CI:1.31-1.35). There was an inverse graded association betwee...
2007
Epidemiology of CKD 1 vi71 decided to analyze the rate of progression of CKD in a population followed by a multidisciplinary team. Methods: We analyzed data from 209 patients (102 females) referred to the Nephrology Division, after at least 6 months under treatment by a multidisciplinary team (nephrologist, nutritionist, nurse and psychologist) patients were followed from January of 2002 until December of 2005. Glomerular filtration rate was estimated by MDRD equation (eGFR). Patients with eGFR below 15ml/min were excluded, and this value was considered the end-point for calculation of the rate of decline of renal function. Results are mean± SD. Results: Hypertension was the main cause of CKD (31%) followed by Diabetes (26%). Age was 60±15 years, body mass index was 27±5 kg.m 2 for females and 26±4 kg.m 2 for males. Serum calcium, phosphorus and albumin were normal. Urea was 71±36mg/dl, eGFR = 38±20 ml/min. Systolic arterial pressure was 137±20mmHg and diastolic= 80±11mmHg; hematocrit = 37±5%, hemoglobin =12.3±1.7g/dl; cholesterol= 194±42mg/dl, HDL-cholesterol= 36±11mg/dl, LDL-cholesterol= 119±54mg/dl; triglyceride = 167±106 mg/dl; iPTH= 221±221 pg/ml. From the studied population 58% was referred to treatment with eGFR = 45-30 ml/min, and the remaining with eGFR =29 to 15 ml/min. K/DOQUI suggests a decline of 4ml/min/year for CKD patients. As shown in Table1, the rate of decline of eGFR of the present population was below this level, meaning an extra gain of time per year free from dialysis as a consequence of the conservative management with a multidisciplinary team. Table1. Progression of CKD Baseline disease Initial eGFR GFR reduction Time expectancy Time gain/year (ml/min) (ml/min/yr) in conservative in conservative management (yrs) management (yrs) Diabetes 40.48 2.88
Editorial: Glomerular filtration rate in Chronic Kidney Disease
Frontiers in Medicine, 2023
Editorial on the Research Topic Glomerular filtration rate in Chronic Kidney Disease Chronic Kidney Disease (CKD) is defined as "abnormalities of kidney structure or function, present for more than 3 months, with health implications" and is classified according to the cause, the glomerular filtration rate (GFR) category, and the magnitude of albuminuria (1). So, the diagnosis of CKD progression is based on two key parameters: GFR and the presence and extent of albuminuria. GFR is considered the best global index of renal function since its decrease usually correlates with functional renal mass. GFR can be easily estimated (eGFR) through equations that include endogenous analytes such as creatinine or cystatin C, alone or combined, and anthropometric and demographic factors. At the individual level, the accuracy of an eGFR equation is defined as (p30), which means that around 85% of GFR determinations are within ±30% of mGFR. eGFR should not be used when extreme body composition is present, such as patients with anorexia nervosa, cirrhosis, debilitated elderly, severe obesity, or when there is a need to administer nephrotoxic drugs with a narrow therapeutic option. When necessary, mGFR can be measured using radioisotopes or contrast media. The understanding that a reliable and consistent GFR estimation (which means reproducibility under the same conditions) is central for the practice of nephrology in particular and medicine in general. Taking into account its limitations, at present, eGFR is not only a powerful tool for identifying CKD, but it has become fundamental for physicians for early detection, clinical diagnosis, monitoring of progression, indication for admission to replacement therapy, calculation of the dose of drugs excreted by the kidney, and in preparation for invasive diagnostic or therapeutic procedures. As an epidemiological tool, eGFR is not only a simple method to estimate the global burden of CKD, but an instrument for identifying risk factors for progression, understanding the epidemiology of kidney disease concerning different social groups (particularly vulnerable ones), and establishing public policies that intend to reduce CKD at the population level. In kidney disease investigation, it is necessary to determine the risks and benefits of new drugs over CKD progression.
Change in Measured GFR Versus eGFR and CKD Outcomes
Journal of the American Society of Nephrology : JASN, 2015
Measured GFR (mGFR) has long been considered the gold standard measure of kidney function, but recent studies have shown that mGFR is not consistently superior to eGFR in explaining CKD-related comorbidities. The associations between longitudinal changes in mGFR versus eGFR and adverse outcomes have not been examined. We analyzed a subset of 942 participants with CKD in the Chronic Renal Insufficiency Cohort Study who had at least two mGFRs and two eGFRs determined concurrently by iothalamate and creatinine (eGFRcr) or cystatin C, respectively. We compared the associations between longitudinal changes in each measure of kidney function over 2 years and risks of ESRD, nonfatal cardiovascular events, and all-cause mortality using univariate Cox proportional hazards models. The associations for all outcomes except all-cause mortality associated most strongly with longitudinal decline in eGFRcr. Every 5-ml/min per 1.73 m(2) decline in eGFRcr over 2 years associated with 1.54 (95% confid...
2014
Background: Uncertainty exists regarding the optimal method to estimate glomerular filtration rate (GFR) for disease detection and monitoring. Widely used GFR estimates have not been validated in British ethnic minority populations. Methods/design: Iohexol measured GFR will be the reference against which each estimating equation will be compared. The estimating equations will be based upon serum creatinine and/or cystatin C. The eGFR-C study has 5 components: 1) A prospective longitudinal cohort study of 1300 adults with stage 3 chronic kidney disease followed for 3 years with reference (measured) GFR and test (estimated GFR [eGFR] and urinary albumin-to-creatinine ratio) measurements at baseline and 3 years. Test measurements will also be undertaken every 6 months. The study population will include a representative sample of South-Asians and African-Caribbeans. People with diabetes and proteinuria (ACR ≥30 mg/mmol) will comprise 20-30% of the study cohort. 2) A sub-study of pattern...
Ibrahim Medical College Journal, 2016
Chronic kidney disease (CKD) with diabetes mellitus is one of the most common and major public health problems globally. In Bangladesh, several studies indicate an increasing prevalence of diabetes though very few studies are available on CKD. For CKD, diagnostic method, criteria or cutoffs still remained undecided. This study aimed to determine the prevalence of CKD among the hospitalized patients and to compare the diagnostic approach practiced in the hospital. Methods: All patients admitted to the Department of Nephrology at BIRDEM from May 1 to July 31, 2012 were selected for investigation. An almost equal number of patients were also selected from other units of Medicine. The information included were age, sex, social class, blood pressure, height, weight, blood glucose, creatinine, triglycerides, total cholesterol, high-density lipoproteins and electrolytes. The CKD creat was diagnosed based on creatinine (>1.2mg/dl) and the CKD gfr based on estimated GFR (<60 ml/min/1.73m 2) following Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline. The comparisons of characteristics were made between CKD creat and non-CKD creat (≤ 1.2 vs.>1.2 mg/dl) groups. Similar comparisons were also made between CKD gfr and non-CKD gfr (>60 vs. ≤ 60 ml/min/1.73 2) groups. Results: A total of 4172 patients got admitted in the study period of 90 days; and 442 patients (m / f = 256 / 186) were investigated. Of the total (n=4172), 241 (5.8%) had CKD creat and 272 (6.5%) had CKD gfr. Of the investigated 442 patients, 241 (54.5%) had CKD creat and 272 (61.5%) had CKD gfr. The differences of characteristics between CKD creat and non-CKD creat groups were almost similar to the differences between CKD gfr and non-CKD gfr groups. Higher age, higher social class and higher blood pressure showed significant (p<0.001) and similar associations with both CKD creat and CKD gfr. Interestingly, if the cutoff of eGFR is taken at <90 ml/min/1.73 2 , as suggested by K/DOQI, the prevalence of CKD gfr increases to 86.7%. This indicates a wide variation (32.2%) between the two criteria (CKD creat : creat >1.2 mg/dl and CKD gfr : <90 ml/min/1.73 2). Thus, a large proportion remained either under-or over-diagnosed depending on the criterion used. Conclusion: The prevalence of CKD among the hospitalized patients was found not negligible. The comparisons of two diagnostic criteria did differ and eGFR (K/DOQI) could detect higher proportion of CKD, which might be an over-diagnosis. Further study taking microalbuminuria, gross proteinuria, albumin-creatinine ratio and cystatin C may validate the method for the diagnostic accuracy of CKD, which my help assessing the prevalence of CKD accurately.
Automated reporting of eGFR: a useful tool for identifying and managing kidney disease
The Medical journal of Australia, 2009
Estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula has been shown to provide unbiased and acceptably accurate estimates of measured GFR across a broad range of individuals with impaired kidney function. eGFR is superior to measuring serum creatinine (SCr) concentration alone, more accurate than other prediction formulas (such as Cockcroft-Gault) in the setting of reduced kidney function, and more practical and reliable under most circumstances than measuring urinary creatinine clearance. Routine eGFR reporting with requests for SCr, in concert with clinician education, has been shown to enhance the detection of chronic kidney disease (CKD), resulting in improved cardiac and renal outcomes for patients. eGFR has been shown to effectively identify individuals at increased risk of adverse drug reactions (even when SCr concentration is in the normal range). For most drugs prescribed in primary care and for most patients of average age and...
eGFR: Is It Ready for Early Identification of CKD?
Clinical Journal of the American Society of Nephrology, 2008
Reporting estimated glomerular filtration rate (eGFR) with serum creatinine simply provides the information for which the serum creatinine was ordered in the first place. Mass or universal screening is not the purpose of eGFR reporting. Furthermore, such mass screening does not seem justified. Rather, testing of high-risk groups with eGFR and urinary albumin is useful. Population estimates of the prevalence of chronic kidney disease in the United States that use the Kidney Disease Outcomes Quality Initiative staging system lead to disturbingly high estimates. Many of these people are elderly with marginally depressed GFRs and for whom there are no known therapeutic implications. However, an even more disturbing fraction of people with serious and progressive renal disease are not diagnosed, counseled, or treated. Reporting of eGFR is only one tool in attempting to rectify this latter problem. Nephrologists need to educate patients and their primary care colleagues in the use of this tool.