ArticleBMC nephrology2015
Variability in estimated glomerular filtration rate values is a risk factor in chronic kidney disease progression among patients with diabetes.
Article in BMC nephrology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Is eGFR Slope a Novel Predictor of Chronic Complications of Type 2 Diabetes Mellitus? A Systematic Review and Meta-Analysis.Journal of diabetes research · 2024Pooled it
- The Impact of Non-AKI eGFR Variability on CKD Progression in Individuals With Type 2 Diabetes and Preserved Kidney Function.Kidney international reports · 2026Article
- Article
- Estimated Glomerular Filtration Rate Variability in Patients with Diabetes Receiving SGLT2 Inhibitors Versus DPP4 Inhibitors.Pharmaceutics · 2025Article
- Time-Updated Estimated GFR Variability Is Associated With Mortality, Cardiovascular Disease, and End-Stage Kidney Disease in Patients With CKD: Findings From the CRIC Study.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2025Article
- Article
- Genetics of longitudinal kidney function in children and adults with systemic lupus erythematosus.Rheumatology (Oxford, England) · 2023Article
- GFR Variability, Survival, and Cardiovascular Events in Older Adults.Kidney medicine · 2023Article
- Interpreting Estimated GFR Variability and Its Clinical Significance.Kidney medicine · 2023Article
- Review
- A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study.Cardiovascular diabetology · 2021Observational
- Estimated GFR Variability and Risk of Cardiovascular Events and Mortality in SPRINT (Systolic Blood Pressure Intervention Trial).American journal of kidney diseases : the official journal of the National Kidney Foundation · 2021Article
- American Indian chronic Renal insufficiency cohort study (AI-CRIC study).BMC nephrology · 2020Article
- Variability in estimated glomerular filtration rate and the incidence of type 2 diabetes: a nationwide population-based study.BMJ open diabetes research & care · 2020Article
- Fluctuating renal function and the risk of incident atrial fibrillation: a nationwide population-based study.Scientific reports · 2019Article
- Article
- Serum carbohydrate antigen 153 and renal function in patients with type 2 diabetes mellitus.Journal of clinical laboratory analysis · 2018Article
- High serum creatinine nonlinearity: a renal vital sign?American journal of physiology. Renal physiology · 2016Review
- Article
- Estimated Glomerular Filtration Rate Slope Predicts Survival and Renal Outcomes in Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis: Development and Validation of a Pathogen-Free Model.Kidney diseases (Basel, Switzerland)Article
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7 authors.
Funding
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Abstract
backgroundIt is unknown whether variability of estimated Glomerular Filtration Rate (eGFR) is a risk factor for dialysis or death in patients with chronic kidney disease (CKD). This study aimed to evaluate variability of estimated Glomerular Filtration Rate (eGFR) as a risk factor for dialysis or death to facilitate optimum care among high risk patients.
methodsA longitudinal retrospective cohort study of 70,598 Veterans Health Administration veteran patients with diabetes and CKD (stage 3-4) in 2000 with up to 5 years of follow-up. VHA and Medicare files were linked to derive study variables. We used Cox proportional hazards models to evaluate association between time to initial dialysis/death and key independent variables: time-varying eGFR variability (measured by standard deviation (SD)) and eGFR means and slopes while adjusting for prior hospitalizations, and comorbidities.
resultsThere were 76.7% older than 65 years, 97.5% men, and 81.9% Whites. Patients were largely in early stage 3 (61.2%), followed by late stage 3 (28.9%), and stage 4 (9.9%); 29.1%, 46.8%, and 73.3%, respectively, died or had dialysis during the follow-up. eGFR SDs (median: 5.8, 5.1, and 4.0 ml/min/1.73 m(2)) and means (median: 54.1, 41.0, 27.2 ml/min/1.73 m(2)) from all two-year moving intervals decreased as CKD advanced; eGFR variability (relative to the mean) increased when CKD progressed (median coefficient of variation: 10.9, 12.8, and 15.4). Cox regressions revealed that one unit increase in a patient's standard deviation of eGFRs from prior two years was significantly associated with about 7% increase in risk of dialysis/death in the current year, similarly in all three CKD stages. This was after adjusting for concurrent means and slopes of eGFRs, demographics, prior hospitalization, and comorbidities. For example, the hazard of dialysis/death increased by 7.2% (hazard ratio:1.072; 95% CI = 1.067, 1.080) in early stage 3.
conclusioneGFR variability was independently associated with elevated risk of dialysis/death even after controlling for eGFR means and slopes.
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