EGFR decline linked to renal outcomes in diabetic kidney disease

The 1-year decline in estimated glomerular filtration rate (eGFR) appears to be a useful indicator of cardiovascular and renal risk among patients with diabetic kidney disease (DKD), a new study has found.

Drawing from the EMPATHY trial, researchers enrolled 4,461 DKD patients who participated in the study. Change in eGFR was determined after measurements were collected a year after first enrolment.

EMPATHY’s primary composite endpoint included cardiac (myocardial infarction, coronary revascularization, unstable angina), cerebral (ischaemic stroke or cerebral revascularization), renal (initiation of chronic dialysis, doubling serum creatinine), and vascular (aortic or peripheral arterial disease) components. These were also used in the present study.

Receiver operating characteristic (ROC) curve analysis found that the 1-year eGFR decline was accurate in predicting the renal endpoint, with an area under the curve (AUC) of 0.880, and sensitivity and specificity values of 0.851 and 0.744, respectively.  

In addition, a fast drop in eGFR over a year was highly predictive of the renal outcome (AUC, 0.967, 95 percent confidence interval [CI], 0.950–0.983).

Cox regression analysis further confirmed that a large 1-year decline in eGFR was a strong risk factor for the renal endpoint, increasing its likelihood by almost tenfold (hazard ratio, 9.948, 95 percent CI, 4.124–23.996; p<0.0001).

“Information on 1-year eGFR decline proved to be a useful predictive value in addition to the conventional risk factors,” the researchers said. “Therefore, clinicians should be cautious and take note of the eGFR trajectory as well as albuminuria or absolute eGFR value itself to help identify patients at a high risk of end-stage renal disease.”