Change in glomerular filtration rate over time in the Oxford Renal Cohort Study: observational study

Jennifer A Hirst; Maarten W Taal; Simon DS Fraser; José M Ordóñez Mena; Chris A O’Callaghan; Richard J Mcmanus; Clare J Taylor; Yaling Yang; Emma Ogburn; F D Richard Hobbs

doi:10.3399/BJGP.2021.0477

Change in glomerular filtration rate over time in the Oxford Renal Cohort Study: observational study

Jennifer A Hirst, Maarten W Taal, Simon DS Fraser, José M Ordóñez Mena, Chris A O’Callaghan, Richard J Mcmanus, Clare J Taylor, Yaling Yang, Emma Ogburn, F D Richard Hobbs

Applied Health Research

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Abstract

Background: Decline in kidney function can result in adverse health outcomes. The Oxford Renal Cohort Study has detailed baseline assessments from 884 participants ≥60 years of age.

Aim: To determine the proportion of participants with a decline in estimated glomerular filtration rate (eGFR), identify determinants of decline, and determine proportions with chronic kidney disease (CKD) remission.

Design and setting: Observational cohort study in UK primary care.

Method: Data were used from baseline and annual follow-up assessments to monitor change in kidney function. Rapid eGFR decline was defined as eGFR decrease >5 ml/min/1.73 m²/year, improvement as eGFR increase >5 ml/min/1.73 m²/year, and remission in those with CKD at baseline and eGFR >60 ml/min/1.73 m² during follow-up. Cox proportional hazard models were used to identify factors associated with eGFR decline.

Results: There was a net decline in eGFR in the 884 participants over 5 years of follow-up. In 686 participants with >2 eGFR tests with a median follow-up of 2.1 years, 164 (24%) evidenced rapid GFR decline, 185 (27%) experienced eGFR improvement, and 82 of 394 (21%) meeting CKD stage 1-4 at baseline experienced remission. In the multivariable analysis, smoking status, higher systolic blood pressure, and being known to have CKD at cohort entry were associated with rapid GFR decline. Those with CKD stage 3 at baseline were less likely to exhibit GFR decline compared with normal kidney function.

Conclusion: This study established that 24% of people evidenced rapid GFR decline whereas 21% evidenced remission of CKD. People at risk of rapid GFR decline may benefit from closer monitoring and appropriate treatment to minimise risks of adverse outcomes, although only a small proportion meet the National Institute for Health and Care Excellence criteria for referral to secondary care.

Original language	English
Pages (from-to)	E261-E268
Number of pages	8
Journal	British Journal of General Practice
Volume	72
Issue number	717
Early online date	31 Mar 2022
DOIs	https://doi.org/10.3399/BJGP.2021.0477
Publication status	Published - Apr 2022

Bibliographical note

Funding Information:
The research was funded/supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Jennifer A Hirst and José M Ordóñez Mena are funded by the NIHR BRC, Oxford. Clare J Taylor is funded by an NIHR Academic Clinical Lectureship. FD Richard Hobbs acknowledges part-support from the NIHR Applied Research Collaboration Oxford Thames Valley, and the NIHR Oxford Biomedical Research Centre (OUHT BRC). Richard J McManus acknowledges part-support from the NIHR Collaboration for Leadership in Applied Research in Health and Care Oxford.

Publisher Copyright:
© The Authors

Keywords

chronic kidney diseases
cohort studies
glomerular filtration rate
primary care

ASJC Scopus subject areas

Family Practice

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Cite this

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title = "Change in glomerular filtration rate over time in the Oxford Renal Cohort Study: observational study",

abstract = "Background: Decline in kidney function can result in adverse health outcomes. The Oxford Renal Cohort Study has detailed baseline assessments from 884 participants ≥60 years of age. Aim: To determine the proportion of participants with a decline in estimated glomerular filtration rate (eGFR), identify determinants of decline, and determine proportions with chronic kidney disease (CKD) remission. Design and setting: Observational cohort study in UK primary care. Method: Data were used from baseline and annual follow-up assessments to monitor change in kidney function. Rapid eGFR decline was defined as eGFR decrease >5 ml/min/1.73 m2/year, improvement as eGFR increase >5 ml/min/1.73 m2/year, and remission in those with CKD at baseline and eGFR >60 ml/min/1.73 m2 during follow-up. Cox proportional hazard models were used to identify factors associated with eGFR decline. Results: There was a net decline in eGFR in the 884 participants over 5 years of follow-up. In 686 participants with >2 eGFR tests with a median follow-up of 2.1 years, 164 (24%) evidenced rapid GFR decline, 185 (27%) experienced eGFR improvement, and 82 of 394 (21%) meeting CKD stage 1-4 at baseline experienced remission. In the multivariable analysis, smoking status, higher systolic blood pressure, and being known to have CKD at cohort entry were associated with rapid GFR decline. Those with CKD stage 3 at baseline were less likely to exhibit GFR decline compared with normal kidney function. Conclusion: This study established that 24% of people evidenced rapid GFR decline whereas 21% evidenced remission of CKD. People at risk of rapid GFR decline may benefit from closer monitoring and appropriate treatment to minimise risks of adverse outcomes, although only a small proportion meet the National Institute for Health and Care Excellence criteria for referral to secondary care.",

keywords = "chronic kidney diseases, cohort studies, glomerular filtration rate, primary care",

author = "Hirst, {Jennifer A} and Taal, {Maarten W} and Fraser, {Simon DS} and Mena, {Jos{\'e} M Ord{\'o}{\~n}ez} and O{\textquoteright}Callaghan, {Chris A} and Mcmanus, {Richard J} and Taylor, {Clare J} and Yaling Yang and Emma Ogburn and Hobbs, {F D Richard}",

note = "Funding Information: The research was funded/supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Jennifer A Hirst and Jos{\'e} M Ord{\'o}{\~n}ez Mena are funded by the NIHR BRC, Oxford. Clare J Taylor is funded by an NIHR Academic Clinical Lectureship. FD Richard Hobbs acknowledges part-support from the NIHR Applied Research Collaboration Oxford Thames Valley, and the NIHR Oxford Biomedical Research Centre (OUHT BRC). Richard J McManus acknowledges part-support from the NIHR Collaboration for Leadership in Applied Research in Health and Care Oxford. Publisher Copyright: {\textcopyright} The Authors",

year = "2022",

month = apr,

doi = "10.3399/BJGP.2021.0477",

language = "English",

volume = "72",

pages = "E261--E268",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "717",

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TY - JOUR

T1 - Change in glomerular filtration rate over time in the Oxford Renal Cohort Study

T2 - observational study

AU - Hirst, Jennifer A

AU - Taal, Maarten W

AU - Fraser, Simon DS

AU - Mena, José M Ordóñez

AU - O’Callaghan, Chris A

AU - Mcmanus, Richard J

AU - Taylor, Clare J

AU - Yang, Yaling

AU - Ogburn, Emma

AU - Hobbs, F D Richard

N1 - Funding Information: The research was funded/supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Jennifer A Hirst and José M Ordóñez Mena are funded by the NIHR BRC, Oxford. Clare J Taylor is funded by an NIHR Academic Clinical Lectureship. FD Richard Hobbs acknowledges part-support from the NIHR Applied Research Collaboration Oxford Thames Valley, and the NIHR Oxford Biomedical Research Centre (OUHT BRC). Richard J McManus acknowledges part-support from the NIHR Collaboration for Leadership in Applied Research in Health and Care Oxford. Publisher Copyright: © The Authors

PY - 2022/4

Y1 - 2022/4

N2 - Background: Decline in kidney function can result in adverse health outcomes. The Oxford Renal Cohort Study has detailed baseline assessments from 884 participants ≥60 years of age. Aim: To determine the proportion of participants with a decline in estimated glomerular filtration rate (eGFR), identify determinants of decline, and determine proportions with chronic kidney disease (CKD) remission. Design and setting: Observational cohort study in UK primary care. Method: Data were used from baseline and annual follow-up assessments to monitor change in kidney function. Rapid eGFR decline was defined as eGFR decrease >5 ml/min/1.73 m2/year, improvement as eGFR increase >5 ml/min/1.73 m2/year, and remission in those with CKD at baseline and eGFR >60 ml/min/1.73 m2 during follow-up. Cox proportional hazard models were used to identify factors associated with eGFR decline. Results: There was a net decline in eGFR in the 884 participants over 5 years of follow-up. In 686 participants with >2 eGFR tests with a median follow-up of 2.1 years, 164 (24%) evidenced rapid GFR decline, 185 (27%) experienced eGFR improvement, and 82 of 394 (21%) meeting CKD stage 1-4 at baseline experienced remission. In the multivariable analysis, smoking status, higher systolic blood pressure, and being known to have CKD at cohort entry were associated with rapid GFR decline. Those with CKD stage 3 at baseline were less likely to exhibit GFR decline compared with normal kidney function. Conclusion: This study established that 24% of people evidenced rapid GFR decline whereas 21% evidenced remission of CKD. People at risk of rapid GFR decline may benefit from closer monitoring and appropriate treatment to minimise risks of adverse outcomes, although only a small proportion meet the National Institute for Health and Care Excellence criteria for referral to secondary care.

AB - Background: Decline in kidney function can result in adverse health outcomes. The Oxford Renal Cohort Study has detailed baseline assessments from 884 participants ≥60 years of age. Aim: To determine the proportion of participants with a decline in estimated glomerular filtration rate (eGFR), identify determinants of decline, and determine proportions with chronic kidney disease (CKD) remission. Design and setting: Observational cohort study in UK primary care. Method: Data were used from baseline and annual follow-up assessments to monitor change in kidney function. Rapid eGFR decline was defined as eGFR decrease >5 ml/min/1.73 m2/year, improvement as eGFR increase >5 ml/min/1.73 m2/year, and remission in those with CKD at baseline and eGFR >60 ml/min/1.73 m2 during follow-up. Cox proportional hazard models were used to identify factors associated with eGFR decline. Results: There was a net decline in eGFR in the 884 participants over 5 years of follow-up. In 686 participants with >2 eGFR tests with a median follow-up of 2.1 years, 164 (24%) evidenced rapid GFR decline, 185 (27%) experienced eGFR improvement, and 82 of 394 (21%) meeting CKD stage 1-4 at baseline experienced remission. In the multivariable analysis, smoking status, higher systolic blood pressure, and being known to have CKD at cohort entry were associated with rapid GFR decline. Those with CKD stage 3 at baseline were less likely to exhibit GFR decline compared with normal kidney function. Conclusion: This study established that 24% of people evidenced rapid GFR decline whereas 21% evidenced remission of CKD. People at risk of rapid GFR decline may benefit from closer monitoring and appropriate treatment to minimise risks of adverse outcomes, although only a small proportion meet the National Institute for Health and Care Excellence criteria for referral to secondary care.

KW - chronic kidney diseases

KW - cohort studies

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ER -

Change in glomerular filtration rate over time in the Oxford Renal Cohort Study: observational study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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