#5590 pre-dialysis trajectories of estimated gfr and concurrent trends of ckd-relevant biomarkers

Abstract Background and Aims The glomerular filtration rate (GFR) decline varies in patients with advanced chronic kidney disease (CKD), and the concurrent changes in CKD-related biomarkers are unclear. Method We adopted a group-based trajectory model to categorize CKD patients by their pre-dialysis eGFR trajectory and then analyzed the concurrent changing trends of CKD-relevant biomarkers, including urine protein-creatinine ratio (UPCR), albumin, and uric acid. Results Using longitudinal data from two years before dialysis initiation, 1,758 CKD patients were included. We identified three distinct eGFR trajectories: persistently low eGFR levels, progressive loss of eGFR, and accelerated loss of eGFR. Eight of the 15 biomarkers showed distinct patterns among the trajectory groups. Compared to the group with persistently low eGFR values, the other two groups were associated with a more rapid increase in the serum urea level and UPCR, especially in the year before dialysis initiation, and a more rapid decline in hemoglobin and platelet counts. Rapid eGFR decline was associated with lower levels of albumin and potassium, and higher levels of MCHC and WBC. The albumin level in the group with an accelerated loss of eGFR was below the normal range. Overall, there was a total of 691 (39.3%) deaths observed during the follow-up period. In the 2-year and 5-year follow-up, 302 (17.2%) and 549 (31.2%) deaths were observed, respectively. The corresponding median follow-up times were 2 years (IQR:1.6 – 2.0) and 3.3 years (IQR:1.6 –5.0). Kaplan–Meier survival plots showed that the eGFR trajectory was significantly associated with the risk of mortality two years and five years after dialysis, with the log-rank test P = .0057 and P = .0001, respectively Conclusion The changes in CKD biomarkers were delineated with disease progression. The results provide information to clinicians and clues to elucidate the mechanism of CKD progression.