eGFR slope as a surrogate endpoint for end-stage kidney disease in patients with diabetes and eGFR > 30 mL/min/1.73 m^2 in the J-DREAMS cohort

Background An analysis of European and American individuals revealed that a reduction in estimated glomerular filtration rate (eGFR) slope by 0.5 to 1.0 mL/min/1.73 m^2 per year is a surrogate endpoint for end-stage kidney disease (ESKD) in patients with early chronic kidney disease.

However, it remains unclear whether this can be extrapolated to Japanese patients.

Methods Using data from the Japan diabetes comprehensive database project based on an advanced electronic medical record system (J-DREAMS) cohort of 51,483 Japanese patients with diabetes and a baseline eGFR ≥ 30 mL/min/1.73 m^2, we examined whether the eGFR slope could be a surrogate indicator for ESKD.

The eGFR slope was calculated at 1, 2, and 3 years, and the relationship between each eGFR slope and ESKD risk was estimated using a Cox proportional hazards model to obtain adjusted hazard ratios (aHRs).

Results Slower eGFR decline by 0.75 mL/min/1.73 m^2/year reduction in 1-, 2-, and 3-year slopes was associated with lower risk of ESKD (aHR 0.93 (95% confidence interval (CI) 0.92–0.95), 0.84 (95% CI 0.82–0.86), and 0.77 (95% CI 0.73–0.82), respectively); this relationship became more apparent as the slope calculation period increased.

Similar results were obtained in subgroup analyses divided by baseline eGFR or baseline urine albumin-creatinine ratio (UACR), with a stronger correlation with ESKD in the baseline eGFR < 60 mL/min/1.73 m^2 group and in the baseline UACR < 30 mg/gCre group.

Conclusion We found that changes in the eGFR slope were associated with ESKD risk in this population.