{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:20Z","timestamp":1786480280859,"version":"build-2736575974"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["K01AG057821"],"award-info":[{"award-number":["K01AG057821"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["P50AG005136"],"award-info":[{"award-number":["P50AG005136"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01HL109315"],"award-info":[{"award-number":["R01HL109315"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01HL109301"],"award-info":[{"award-number":["R01HL109301"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01HL109284"],"award-info":[{"award-number":["R01HL109284"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01HL109282"],"award-info":[{"award-number":["R01HL109282"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01HL109319"],"award-info":[{"award-number":["R01HL109319"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01HL41642"],"award-info":[{"award-number":["U01HL41642"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01HL41652"],"award-info":[{"award-number":["U01HL41652"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01HL41654"],"award-info":[{"award-number":["U01HL41654"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01HL65520"],"award-info":[{"award-number":["U01HL65520"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01HL65521"],"award-info":[{"award-number":["U01HL65521"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["75N92019D00027"],"award-info":[{"award-number":["75N92019D00027"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["75N92019D00028"],"award-info":[{"award-number":["75N92019D00028"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["75N92019D00029"],"award-info":[{"award-number":["75N92019D00029"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["75N92019D00030"],"award-info":[{"award-number":["75N92019D00030"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rapid kidney decline is associated with mortality and cardiovascular disease, even in the absence of CKD. American Indians (AI) have particularly high burden of kidney disease, cardiovascular disease, and stroke. This study aims to examine extreme loss in glomerular function in this population in association with clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Strong Heart Study, a large longitudinal cohort of adult AI participants, collected plasma creatinine at three examination visits between 1989 and 1999. Intraindividual regressions of eGFR provided linear estimates of the change in kidney function over this time. Surveillance with physician adjudication identified mortality and cardiovascular events between visit three through to 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean change in eGFR was loss 6.8 ml\/min over the 10-year baseline (range: \u221266.0 to +28.9 ml\/min). The top 1 percentile lost approximately 5.7 ml\/min per year. Participants with extreme eGFR loss were more likely to have diabetes (95% versus 71%), hypertension (49% versus 33%), or longer smoking history, among smokers (19 pack-years versus 17 pack-years). CKD (eGFR &lt;60 ml\/min) was associated only with mortality, independent of slope: HR, 1.1; 95% CI, 1.0 to 1.3. However, extreme loss in eGFR (&gt;20 ml\/min over baseline period) was associated with mortality, independent of baseline eGFR: HR, 3.5; 95% CI, 2.7 to 4.4, and independently associated with composite CVD events and CHF: HR, 1.4 and 1.7; 95% CI, 1.1 to 1.9 and 1.2 to 2.6, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first examination of decline in eGFR in association with mortality and CVD among AIs. The implications of these findings are broad: clinical evaluation may benefit from evaluating change in eGFR over time in addition to dichotomous eGFR. Also, these findings suggest there may be aspects of renal function that are not well marked by clinical CKD, but which may have particular relevance to long-term renal and vascular health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0000782020","type":"journal-article","created":{"date-parts":[[2020,11,26]],"date-time":"2020-11-26T13:50:11Z","timestamp":1606398611000},"page":"71-78","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Glomerular Filtration Function Decline, Mortality, and Cardiovascular Events: Data from the Strong Heart Study"],"prefix":"10.34067","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5608-7817","authenticated-orcid":false,"given":"Astrid M.","family":"Suchy-Dicey","sequence":"first","affiliation":[{"name":"Elson S Floyd College of Medicine, Washington State University, Spokane, Washington"},{"name":"Institute for Research and Education to Advance Community Health, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Oklahoma University College of Public Health, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sterling","family":"McPherson","sequence":"additional","affiliation":[{"name":"Elson S Floyd College of Medicine, Washington State University, Spokane, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R.","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center, Providence Health Care, Spokane, Washington"},{"name":"Kidney Research Institute, Nephrology Division, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara V.","family":"Howard","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Umans","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dedra S.","family":"Buchwald","sequence":"additional","affiliation":[{"name":"Elson S Floyd College of Medicine, Washington State University, Spokane, Washington"},{"name":"Institute for Research and Education to Advance Community Health, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,1,28]]},"reference":[{"key":"B2-20250825","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1159\/000320749","article-title":"Rapid progression of diabetic nephropathy is linked to inflammation and episodes of acute renal failure","volume":"32","author":"Kelly","year":"2010","journal-title":"Am J Nephrol"},{"key":"B3-20250825","doi-asserted-by":"crossref","first-page":"e92881","DOI":"10.1371\/journal.pone.0092881","article-title":"Estimated glomerular filtration rate decline is a better risk factor for outcomes of systemic disease-related nephropathy than for outcomes of primary renal diseases","volume":"9","author":"Weng","year":"2014","journal-title":"PLoS One"},{"key":"B4-20250825","first-page":"153","article-title":"Slow progression of chronic kidney disease and what it is associated with","volume":"29","author":"Eftimovska","year":"2008","journal-title":"Prilozi"},{"key":"B5-20250825","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1038\/ki.2015.199","article-title":"Biomarkers of rapid chronic kidney disease progression in type 2 diabetes","volume":"88","author":"Looker","year":"2015","journal-title":"Kidney Int"},{"key":"B6-20250825","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1053\/j.ajkd.2015.01.008","article-title":"Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: The Chronic Kidney Disease in Children (CKiD) cohort","volume":"65","author":"Warady","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"B7-20250825","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1681\/ASN.2009121210","article-title":"Rate of kidney function decline associates with mortality","volume":"21","author":"Al-Aly","year":"2010","journal-title":"J Am Soc Nephrol"},{"key":"B8-20250825","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1681\/ASN.2015060688","article-title":"Past decline versus current eGFR and subsequent mortality risk","volume":"27","author":"Naimark","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"B9-20250825","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1038\/ki.2012.281","article-title":"Variability in estimated glomerular filtration rate is an independent risk factor for death among patients with stage 3 chronic kidney disease","volume":"82","author":"Perkins","year":"2012","journal-title":"Kidney Int"},{"key":"B10-20250825","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1053\/j.ajkd.2013.01.019","article-title":"Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system","volume":"62","author":"Derose","year":"2013","journal-title":"Am J Kidney Dis"},{"key":"B11-20250825","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.1681\/ASN.2009010025","article-title":"Change in estimated GFR associates with coronary heart disease and mortality","volume":"20","author":"Matsushita","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"B14-20250825","doi-asserted-by":"crossref","first-page":"3195","DOI":"10.2337\/dc12-2368","article-title":"Insulin resistance, incident cardiovascular diseases, and decreased kidney function among nondiabetic American Indians: The Strong heart study","volume":"36","author":"Zhang","year":"2013","journal-title":"Diabetes Care"},{"key":"B15-20250825","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.2337\/dc09-1652","article-title":"Racial disparities in health status: A comparison of the morbidity among American Indian and U.S. adults with diabetes","volume":"33","author":"O\u2019Connell","year":"2010","journal-title":"Diabetes Care"},{"key":"B16-20250825","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1159\/000369777","article-title":"Cerebral small vessel disease and renal function: Systematic review and meta-analysis","volume":"39","author":"Makin","year":"2015","journal-title":"Cerebrovasc Dis"},{"key":"B17-20250825","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1148\/radiol.2015141913","article-title":"Abnormal intrinsic brain activity patterns in patients with end-stage renal disease undergoing peritoneal dialysis: A resting-state functional MR imaging study","volume":"278","author":"Luo","year":"2016","journal-title":"Radiology"},{"key":"B18-20250825","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/ndt\/gfn419","article-title":"Relationship between silent brain infarction and chronic kidney disease","volume":"24","author":"Kobayashi","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"B19-20250825","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/ijs.12465","article-title":"Kidney function and cerebral small vessel disease in the general population","volume":"10","author":"Akoudad","year":"2015","journal-title":"Int J Stroke"},{"key":"B20-20250825","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1053\/j.ajkd.2005.10.029","article-title":"Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD","volume":"47","author":"Martinez-Vea","year":"2006","journal-title":"Am J Kidney Dis"},{"key":"B21-20250825","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1093\/ajh\/hpu243","article-title":"Sleep duration, kidney function, and their effects on cerebral small vessel disease in elderly hypertensive patients","volume":"28","author":"Nagai","year":"2015","journal-title":"Am J Hypertens"},{"key":"B22-20250825","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1681\/ASN.2014111118","article-title":"Kidney function and cerebral blood flow: The rotterdam study","volume":"27","author":"Sedaghat","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"B23-20250825","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.maturitas.2012.01.008","article-title":"The association of chronic kidney disease with brain lesions on MRI or CT: A systematic review","volume":"71","author":"Vogels","year":"2012","journal-title":"Maturitas"},{"key":"B24-20250825","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1161\/01.STR.0000153065.39325.fd","article-title":"Ethnic disparities in stroke: Epidemiology, acute care, and postacute outcomes","volume":"36","author":"Stansbury","year":"2005","journal-title":"Stroke"},{"key":"B25-20250825","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1161\/CIRCULATIONAHA.105.560607","article-title":"Defining disparities in cardiovascular disease for American Indians: Trends in heart disease and stroke mortality among American Indians and whites in Montana, 1991 to 2000","volume":"112","author":"Harwell","year":"2005","journal-title":"Circulation"},{"key":"B26-20250825","first-page":"e146","article-title":"Heart disease and stroke statistics-2017 update: A report from the American Heart Association [published correction appears in Circulation 135: e646, 2017 10.1161\/CIR.0000000000000491]","volume":"135","author":"Benjamin","year":"2017","journal-title":"Circulation"},{"key":"B27-20250825","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1093\/oxfordjournals.aje.a115757","article-title":"The Strong Heart Study. A study of cardiovascular disease in American Indians: Design and methods","volume":"132","author":"Lee","year":"1990","journal-title":"Am J Epidemiol"},{"key":"B28-20250825","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1053\/j.ajkd.2012.06.015","article-title":"Estimated GFR and incident cardiovascular disease events in American Indians: The Strong Heart Study","volume":"60","author":"Shara","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"B29-20250825","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1161\/CIRCULATIONAHA.108.772285","article-title":"Incidence and risk factors for stroke in American Indians: The Strong Heart Study","volume":"118","author":"Zhang","year":"2008","journal-title":"Circulation"},{"key":"B30-20250825","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1161\/HYPERTENSIONAHA.116.07139","article-title":"Visit-to-visit blood pressure variability: An insight into the mechanisms","volume":"68","author":"Mancia","year":"2016","journal-title":"Hypertension"},{"key":"B31-20250825","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/MBP.0b013e3283624b24","article-title":"Visit-to-visit variability of blood pressure: Current knowledge and future research directions","volume":"18","author":"Muntner","year":"2013","journal-title":"Blood Press Monit"},{"key":"B32-20250825","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1093\/ajh\/hpt092","article-title":"Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study","volume":"26","author":"Suchy-Dicey","year":"2013","journal-title":"Am J Hypertens"},{"key":"B33-20250825","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/HJH.0000000000000779","article-title":"Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease","volume":"34","author":"Chang","year":"2016","journal-title":"J Hypertens"},{"key":"B34-20250825","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/j.1365-2362.2011.02574.x","article-title":"Visit-to-visit variability in blood pressure strongly predicts all-cause mortality in patients with type 2 diabetes: A 5\u00b75-year prospective analysis","volume":"42","author":"Hsieh","year":"2012","journal-title":"Eur J Clin Invest"},{"key":"B35-20250825","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/ene.12310","article-title":"Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct","volume":"21","author":"Lau","year":"2014","journal-title":"Eur J Neurol"},{"key":"B36-20250825","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s11906-014-0527-8","article-title":"Visit-to-visit variability of systolic blood pressure and cardiovascular disease","volume":"17","author":"Hussein","year":"2015","journal-title":"Curr Hypertens Rep"},{"key":"B37-20250825","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1038\/ki.2013.132","article-title":"Long-term visit-to-visit office blood pressure variability increases the risk of adverse cardiovascular outcomes in patients with chronic kidney disease","volume":"84","author":"Mallamaci","year":"2013","journal-title":"Kidney Int"},{"key":"B38-20250825","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1093\/ajh\/hpt167","article-title":"Visit-to-visit blood pressure variability, silent cerebral injury, and risk of stroke","volume":"26","author":"Nagai","year":"2013","journal-title":"Am J Hypertens"},{"key":"B39-20250825","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1186\/1471-2261-14-188","article-title":"Visit-to-visit blood pressure variability is a marker of cardiac diastolic function and carotid atherosclerosis","volume":"14","author":"Okada","year":"2014","journal-title":"BMC Cardiovasc Disord"},{"key":"B40-20250825","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/MNH.0b013e32835b489f","article-title":"Visit-to-visit blood pressure variability and risk for progression of cardiovascular and renal diseases","volume":"22","author":"Rossignol","year":"2013","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"B41-20250825","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3109\/10641963.2014.897724","article-title":"Visit-to-visit variability in systolic blood pressure: Correlated with the changes of arterial stiffness and myocardial perfusion in on-treated hypertensive patients","volume":"37","author":"Song","year":"2015","journal-title":"Clin Exp Hypertens"},{"key":"B42-20250825","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1097\/WAD.0000000000000040","article-title":"Visit-to-visit blood pressure variability in Alzheimer disease","volume":"28","author":"Lattanzi","year":"2014","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"B43-20250825","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1097\/HJH.0000000000000979","article-title":"Visit-to-visit blood pressure variability and future functional decline in old age","volume":"34","author":"Ogliari","year":"2016","journal-title":"J Hypertens"},{"key":"B44-20250825","doi-asserted-by":"crossref","first-page":"f4600","DOI":"10.1136\/bmj.f4600","article-title":"Association of visit-to-visit variability in blood pressure with cognitive function in old age: Prospective cohort study","volume":"347","author":"Sabayan","year":"2013","journal-title":"BMJ"}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000782020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:01:41Z","timestamp":1786478501000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000782020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000782020","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]},"assertion":[{"value":"2020-02-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}