A Lesser Decline in eGFR May Be an Alternative End Point for CKD Progression

Declines in eGFR smaller than those thought to mark CKD progression are associated with ESRD and mortality, according to a JAMAmeta-analysis that included 1.7 million participants. A doubling of serum creatinine, corresponding to a 57% decline in eGFR, was associated with a ˃30-fold higher risk of ESRD. However, over a 1- to 3-year period, doubling of serum creatinine occurred in <1% of participants. A 30% decline in eGFR was nearly 10 times more common and was associated with a fivefold increased risk of ESRD. Although weaker than ESRD risk, associations with mortality were qualitatively similar.