Actionable Insights Newsletter

Translating research to power whole health

Issue 11 |  April 2025

eGFR monitoring crucial in managing chronic kidney disease progression 

Tracking changes in eGFR can help identify rapid progressors of chronic kidney disease, paving the way for earlier interventions and improved patient outcomes. 

Domain(s): cardiometabolic

Summary

Background
Chronic kidney disease (CKD) can progress rapidly, increasing the risk of kidney failure, a serious and costly outcome. Identifying patients at risk of this rapid progression is crucial for prevention.

Current methods track changes in kidney function by monitoring estimated glomerular filtration rate (eGFR) over time. However, there is no universally accepted standard for measuring rapid progression, as methods vary in number of data points used and time frame.


Objective
This study aimed to explore how four different methods of calculating change in eGFR, by using slope derived from multiple data points, impact the prevalence of rapid progression and the ability to predict kidney failure.

Methods
We selected patients from the Healthcare Integrated Research Database (HIRD®) who had at least one eGFR result between January 1, 2016, and December 31, 2019. These patients were divided into four cohorts based on the number of eGFR assessments (>2 vs >3) and the assessment duration (one year vs. two years). We defined rapid progression as slope of -3 ml/min/1.73m²/year in eGFR, based on a review of the literature and prior work in this area. 

Results

• The prevalence of rapid progression ranged from 50.0% to 59.1%. It was lower with two years of data (50.5% and 50.0%) compared to one year (59.1% and 59.0%). The number of eGFR assessments (>2 vs. >3) did not affect prevalence when the evaluation time frame was consistent.

• All methods for identifying rapid CKD progression showed that individuals identified as rapid progressors were at a higher risk of kidney failure compared to non-rapid progressors (see Figure).

• For the most accurate measurement of progression rate, especially in those with low baseline eGFRs or related comorbidities, we recommend collecting at least three eGFR measurements over a two-year period. 

                      Figure

Key takeaways

• This study underscores the importance of regular eGFR screenings to accurately monitor CKD progression and mitigate the risk of kidney failure.

• We recommend that healthcare providers routinely conduct eGFR tests, allowing for earlier interventions and more effective CKD management, potentially reducing healthcare costs.

• Developing clear guidelines regarding the frequency and duration of these assessments is essential.

Publications

• Richard E, Crowe, CL, Smith J*, Goss A, Steubl D. Rapid progression of chronic kidney disease: Patient characteristics and prediction of end-stage kidney disease. Kidney Med (under review)

For more information on a specific study or to connect with the Actionable Insights Committee,
contact us at [email protected].

Sponsor: Funded by Boehringer Ingelheim Pharmaceuticals, Inc. 

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