| アブストラクト | INTRODUCTION: This analysis examined the baseline characteristics and clinical outcomes of patients with chronic kidney disease (CKD) and rapid or non-rapid estimated glomerular filtration rate (eGFR) decline, using retrospective data from DISCOVER CKD (ClinicalTrials.gov, NCT04034992). METHODS: Data (2008-2020) were extracted from UK Clinical Practice Research Datalink, US TriNetX, US Limited Claims and Electronic Health Record Dataset, and Japan Medical Data Vision. Patients with CKD (two consecutive eGFR measures < 75 mL/min/1.73 m(2) recorded 90-730 days apart) were included. Rapid eGFR decline was defined as an annual decline of > 4 mL/min/1.73 m(2) at 2 years post-index; non-rapid eGFR decline was defined as an annual decline of </= 4 mL/min/1.73 m(2). Clinical outcomes assessed included all-cause mortality, kidney outcomes (composite risk of kidney failure [progression to CKD stage 5] or > 50% eGFR decline, and kidney failure alone), cardiovascular events-including major adverse cardiovascular events (MACE; non-fatal myocardial infarction/stroke and cardiovascular death)-and all-cause hospitalization. RESULTS: Across databases, rapid eGFR decline occurred in 13.7% of 804,237 eligible patients. Mean annual eGFR decline ranged between - 6.21 and - 6.86 mL/min/1.73 m(2) in patients with rapid eGFR decline versus between - 0.11 and - 0.77 mL/min/1.73 m(2) in patients with non-rapid eGFR decline. Rapid eGFR decline was associated with increased comorbidity burden and medication prescriptions. Across databases, the composite risk of kidney failure or > 50% decline in eGFR was significantly greater in patients with rapid versus non-rapid eGFR decline (P < 0.01); all-cause mortality, kidney failure alone, MACE, and all-cause hospitalization each significantly increased in two databases (P < 0.01-0.05). CONCLUSION: Understanding patient factors associated with rapid eGFR decline in patients with CKD may help identify individuals who would benefit from proactive management to minimize the risk of adverse outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT04034992. |
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| 投稿者 | Heerspink, Hiddo; Nolan, Stephen; Carrero, Juan-Jesus; Arnold, Matthew; Pecoits-Filho, Roberto; Garcia Sanchez, Juan Jose; Wittbrodt, Eric; Cabrera, Claudia; Lam, Carolyn S P; Chen, Hungta; Kanda, Eiichiro; Lainscak, Mitja; Pollock, Carol; Wheeler, David C |
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| 組織名 | Department of Clinical Pharmacy and Pharmacology, University of Groningen, P.O.;Box 30.001, 9700 RB, Groningen, The Netherlands. h.j.lambers.heerspink@umcg.nl.;Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.;Department of Medical Epidemiology and Biostatistics, Karolinska Institutet,;Stockholm, Sweden.;Real World Data Science, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.;School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil.;Arbor Research Collaborative for Health, Ann Arbor, MI, USA.;Global Market Access and Pricing, BioPharmaceuticals Medical, AstraZeneca,;Cambridge, UK.;Cardiovascular, Renal, Metabolism Epidemiology, BioPharmaceuticals Medical,;AstraZeneca, Gaithersburg, MD, USA.;Real World Science and Analytics, BioPharmaceuticals Medical, AstraZeneca,;Gothenburg, Sweden.;Department of Cardiology, National Heart Centre, Singapore, Singapore.;Duke-NUS Medical School, Singapore, Singapore.;Medical and Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca,;Gaithersburg, MD, USA.;Kawasaki Medical School, Kurashiki, Japan.;Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.;Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.;Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW,;Australia.;Department of Renal Medicine, University College London, London, UK. |
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