The following is a summary of “GFR Variability, Survival, and Cardiovascular Events in Older Adults,” published in the February 2023 issue of Kidney Medicine by Fravel et al.
Although estimated glomerular filtration rate (eGFR) fluctuations over time are common, whether these changes affect patient care is unclear. The relationship between eGFR variability and cardiovascular disease (CVD) events and the absence of dementia or persistent physical handicap (disability-free survival) was studied (myocardial infarction, stroke, hospitalization for heart failure, or CVD death). The ASPirin in Reducing Events in the Elderly study enrolled 12,549. At the time of recruitment, participants did not have a history of dementia, severe physical impairment, cardiovascular disease, or terminal illness.
Variability in eGFR was calculated by comparing the standard deviations of eGFR readings taken at the baseline, first, and second yearly visits. Disability-free survival and CVD events that occurred after the eGFR variability estimation period were analyzed about the tertiles of eGFR variability.
838 people died, got dementia, or acquired a persistent physical handicap during the median follow-up of 2.7 years following the second annual visit; 379 had a CVD incident. After accounting for confounding factors, those in the top tertile of eGFR variability had a higher risk of mortality, dementia, and disability than those in the bottom tertile (HR, 1.35; 95% CI, 1.14-1.59) and cardiovascular disease (CVD) events (HR, 1.37; 95% CI, 1.06-1.77). These correlations existed between the two groups before chronic renal disease was apparent. Higher inter-individual differences in eGFR are associated with an increased risk of death, dementia, disability, and cardiovascular disease in otherwise healthy older persons.