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Review
. 2024 Jan 4;25(1):1.
doi: 10.31083/j.rcm2501001. eCollection 2024 Jan.

Role of Estimated Glomerular Filtration Rate in Clinical Research: The Never-Ending Matter

Chiara Abenavoli  1   2 , Michele Provenzano  1   2 , Sara H Ksiazek  3 , Lilio Hu  1   2 , Vania Cuna  1   2 , Gaetano La Manna  1   2 , Giorgia Comai  1   2 , Olga Baraldi  1
Affiliations
Review

Role of Estimated Glomerular Filtration Rate in Clinical Research: The Never-Ending Matter

Chiara Abenavoli et al. Rev Cardiovasc Med. .

Abstract

Background: Chronic kidney disease (CKD) burden is crucial both on a global scale and at individual patient level, affecting morbidity and mortality directly and through its effect on both cardiovascular damage and CKD progression to end-stage-kidney-disease (ESKD). Unfortunately, the awareness of CKD is poor, with few CKD patients conscious of the severity of their health status. The principal biomarker of kidney function is estimated glomerular filtration rate (eGFR).

Methods: We searched the literature and present a review article with the aim of summarizing the role of eGFR in clinical research. In particular, we report the eGFR role as a prognostic, enrichment and endpoint biomarker and its role in the early detection of CKD.

Results: eGFR has a major role as a biomarker in clinical research. As a prognostic marker, eGFR reduction is associated with cardiovascular events, ESKD and mortality. As an enrichment biomarker, eGFR values are pivotal for selecting patients to be included in randomized and observational studies; it helps to test a pre-defined drug in early CKD or in more advanced CKD allowing also to avoid screening failures and to shorten the duration of clinical trials. Moreover, eGFR decline (expressed as a percentage of reduction from baseline or continuous slope) can be considered a good endpoint in clinic trials overcoming delays whilst waiting for hard endpoints to develop.

Conclusions: eGFR is a strong clinical measure for both observational and intervention studies. It is also helpful in screening the general population for kidney disease and, in particular, to increase awareness of CKD.

Keywords: biomarker; chronic kidney disease; endpoint; enrichment; epidemiology; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest. Michele Provenzano is serving as Guest Editor of this journal. We declare that Michele Provenzano had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Giuseppe Boriani and Alessandro Cataliotti.

Figures

Fig. 1.
Fig. 1.
Rate of fatal and non-fatal cardiovascular events (myocardial infarction, stroke, heart failure, peripheral vascular disease) in chronic kidney disease patients stratified by stage [32].
Fig. 2.
Fig. 2.
Estimated estimated glomerular filtration rate (eGFR) and its association with several pathophysiologic mechanisms. Estimated GFR reduction is associated with the development of several comorbidities (increase in blood toxin levels, electrolyte imbalances such hyperkalaemia and hyposodiemia, inflammation, arterial hypertension and anemia) that, taken together, dramatically increase the risk for future events.
See this image and copyright information in PMC

References

    1. KDIGO 2023 Clinical practice guideline for the evaluation and management of chronic kidney disease. 2023. [(Accessed: 23 July 2023)]. Available at: https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2023-CKD-Guideline-Pu....
    1. Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Advances in Experimental Medicine and Biology . 2019;1165:3–15. - PubMed
    1. World Health Organization Mortality and global health estimates: Causes of death; Projections for 2015-2030; Projection of death rates. [(Accessed: 7 September 2023)]. Available at: http://apps.who.int/gho/data/node.main.
    1. Xie Y, Bowe B, Mokdad AH, Xian H, Yan Y, Li T, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney International . 2018;94:567–581. - PubMed
    1. Chu CD, McCulloch CE, Banerjee T, Pavkov ME, Burrows NR, Gillespie BW, et al. CKD Awareness Among US Adults by Future Risk of Kidney Failure. American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation . 2020;76:174–183. - PMC - PubMed

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