Decline in Estimated Glomerular Filtration Rate and Subsequent Risk of End-Stage Renal Disease and Mortality

Abstract

Chronic kidney disease (CKD) is a worldwide public health problem, with increasing prevalence, poor outcomes, and high treatment costs.¹ Yet despite the availability of simple laboratory tests to identify people with earlier stages of CKD, there are fewer clinical trials for kidney disease than for other common diseases.² One contributing reason may be that the established end point (ie, a doubling of serum creatinine concentration from baseline, corresponding to a 57% reduction in estimated glomerular filtration rate [GFR]) used to document CKD progression is a late event, requiring long follow-up periods and large sample sizes.^2-4 Improved methods for GFR estimation may allow for use of smaller reductions in estimated GFR (vs a doubling of serum creatinine concentration) as alternative end points to assess CKD progression.^4,5 Evaluation of such alternative end points should include their enumeration and quantification of their relationship with future progression to end-stage renal disease (ESRD) across a wide range of settings. Standardized definitions of CKD progression outcomes would also benefit observational studies and clinical practice.