Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease

a collaborative meta-analysis of kidney disease population cohorts

Brad C Astor, Kunihiro Matsushita, Ron T Gansevoort, Marije van der Velde, Mark Woodward, Andrew S Levey, Paul E de Jong, Josef Coresh, Brad C Astor, Kunihiro Matsushita, Ron T Gansevoort, Marije van der Velde, Mark Woodward, Andrew S Levey, Paul E de Jong, Josef Coresh, Meguid El-Nahas, Kai-Uwe Eckardt, Bertram L Kasiske, Jackson Wright & 30 others Larry Appel, Tom Greene, Adeera Levin, Ognjenka Djurdjev, David C Wheeler, Martin J Landray, John N Townend, Jonathan Emberson, Laura E Clark, Alison Macleod, Angharad Marks, Tariq Ali, Nicholas Fluck, Gordon J Prescott, David H Smith, Jessica R Weinstein, Eric S Johnson, Micah L Thorp, Jack F Wetzels, P J Blankestijn, A D van Zuilen, Vandana Menon, Mark Sarnak, Gerald Beck, Florian Kronenberg, Barbara Kollerits, Marc Froissart, Benedicte Stengel, Marie Metzger, Chronic Kidney Disease Prognosis Consortium

Research output: Contribution to journalArticle

370 Citations (Scopus)

Abstract

We studied here the independent associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in individuals with chronic kidney disease (CKD). We performed a collaborative meta-analysis of 13 studies totaling 21,688 patients selected for CKD of diverse etiology. After adjustment for potential confounders and albuminuria, we found that a 15 ml/min per 1.73 m² lower eGFR below a threshold of 45 ml/min per 1.73 m² was significantly associated with mortality and ESRD (pooled hazard ratios (HRs) of 1.47 and 6.24, respectively). There was significant heterogeneity between studies for both HR estimates. After adjustment for risk factors and eGFR, an eightfold higher albumin- or protein-to-creatinine ratio was significantly associated with mortality (pooled HR 1.40) without evidence of significant heterogeneity and with ESRD (pooled HR 3.04), with significant heterogeneity between HR estimates. Lower eGFR and more severe albuminuria independently predict mortality and ESRD among individuals selected for CKD, with the associations stronger for ESRD than for mortality. Thus, these relationships are consistent with CKD stage classifications based on eGFR and suggest that albuminuria provides additional prognostic information among individuals with CKD.
Original languageEnglish
Pages (from-to)1331-1340
Number of pages10
JournalKidney International
Volume79
Issue number12
DOIs
Publication statusPublished - Jun 2011

Fingerprint

Albuminuria
Kidney Diseases
Glomerular Filtration Rate
Chronic Renal Insufficiency
Chronic Kidney Failure
Meta-Analysis
Mortality
Population
Albumins
Creatinine
Proteins

Keywords

  • adult
  • aged
  • albuminuria
  • biological markers
  • chi-square distribution
  • cohort studies
  • creatine
  • disease progression
  • female
  • glomerular filtration rate
  • humans
  • kidney
  • kidney diseases
  • kidney failure, chronic
  • male
  • middle aged
  • predictive value of tests
  • prognosis
  • proportional hazards models
  • regression analysis
  • risk assessment
  • risk factors

Cite this

Astor, B. C., Matsushita, K., Gansevoort, R. T., van der Velde, M., Woodward, M., Levey, A. S., ... Chronic Kidney Disease Prognosis Consortium (2011). Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease: a collaborative meta-analysis of kidney disease population cohorts. Kidney International, 79(12), 1331-1340. https://doi.org/10.1038/ki.2010.550

Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease : a collaborative meta-analysis of kidney disease population cohorts. / Astor, Brad C; Matsushita, Kunihiro; Gansevoort, Ron T; van der Velde, Marije; Woodward, Mark; Levey, Andrew S; Jong, Paul E de; Coresh, Josef; Astor, Brad C; Matsushita, Kunihiro; Gansevoort, Ron T; van der Velde, Marije; Woodward, Mark; Levey, Andrew S; de Jong, Paul E; Coresh, Josef; El-Nahas, Meguid; Eckardt, Kai-Uwe; Kasiske, Bertram L; Wright, Jackson; Appel, Larry; Greene, Tom; Levin, Adeera; Djurdjev, Ognjenka; Wheeler, David C; Landray, Martin J; Townend, John N; Emberson, Jonathan; Clark, Laura E; Macleod, Alison; Marks, Angharad; Ali, Tariq; Fluck, Nicholas; Prescott, Gordon J; Smith, David H; Weinstein, Jessica R; Johnson, Eric S; Thorp, Micah L; Wetzels, Jack F; Blankestijn, P J; van Zuilen, A D; Menon, Vandana; Sarnak, Mark; Beck, Gerald; Kronenberg, Florian; Kollerits, Barbara; Froissart, Marc; Stengel, Benedicte; Metzger, Marie; Chronic Kidney Disease Prognosis Consortium.

In: Kidney International, Vol. 79, No. 12, 06.2011, p. 1331-1340.

Research output: Contribution to journalArticle

Astor, BC, Matsushita, K, Gansevoort, RT, van der Velde, M, Woodward, M, Levey, AS, Jong, PED, Coresh, J, Astor, BC, Matsushita, K, Gansevoort, RT, van der Velde, M, Woodward, M, Levey, AS, de Jong, PE, Coresh, J, El-Nahas, M, Eckardt, K-U, Kasiske, BL, Wright, J, Appel, L, Greene, T, Levin, A, Djurdjev, O, Wheeler, DC, Landray, MJ, Townend, JN, Emberson, J, Clark, LE, Macleod, A, Marks, A, Ali, T, Fluck, N, Prescott, GJ, Smith, DH, Weinstein, JR, Johnson, ES, Thorp, ML, Wetzels, JF, Blankestijn, PJ, van Zuilen, AD, Menon, V, Sarnak, M, Beck, G, Kronenberg, F, Kollerits, B, Froissart, M, Stengel, B, Metzger, M & Chronic Kidney Disease Prognosis Consortium 2011, 'Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease: a collaborative meta-analysis of kidney disease population cohorts', Kidney International, vol. 79, no. 12, pp. 1331-1340. https://doi.org/10.1038/ki.2010.550
Astor, Brad C ; Matsushita, Kunihiro ; Gansevoort, Ron T ; van der Velde, Marije ; Woodward, Mark ; Levey, Andrew S ; Jong, Paul E de ; Coresh, Josef ; Astor, Brad C ; Matsushita, Kunihiro ; Gansevoort, Ron T ; van der Velde, Marije ; Woodward, Mark ; Levey, Andrew S ; de Jong, Paul E ; Coresh, Josef ; El-Nahas, Meguid ; Eckardt, Kai-Uwe ; Kasiske, Bertram L ; Wright, Jackson ; Appel, Larry ; Greene, Tom ; Levin, Adeera ; Djurdjev, Ognjenka ; Wheeler, David C ; Landray, Martin J ; Townend, John N ; Emberson, Jonathan ; Clark, Laura E ; Macleod, Alison ; Marks, Angharad ; Ali, Tariq ; Fluck, Nicholas ; Prescott, Gordon J ; Smith, David H ; Weinstein, Jessica R ; Johnson, Eric S ; Thorp, Micah L ; Wetzels, Jack F ; Blankestijn, P J ; van Zuilen, A D ; Menon, Vandana ; Sarnak, Mark ; Beck, Gerald ; Kronenberg, Florian ; Kollerits, Barbara ; Froissart, Marc ; Stengel, Benedicte ; Metzger, Marie ; Chronic Kidney Disease Prognosis Consortium. / Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease : a collaborative meta-analysis of kidney disease population cohorts. In: Kidney International. 2011 ; Vol. 79, No. 12. pp. 1331-1340.
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AU - Gansevoort, Ron T

AU - van der Velde, Marije

AU - Woodward, Mark

AU - Levey, Andrew S

AU - Jong, Paul E de

AU - Coresh, Josef

AU - Astor, Brad C

AU - Matsushita, Kunihiro

AU - Gansevoort, Ron T

AU - van der Velde, Marije

AU - Woodward, Mark

AU - Levey, Andrew S

AU - de Jong, Paul E

AU - Coresh, Josef

AU - El-Nahas, Meguid

AU - Eckardt, Kai-Uwe

AU - Kasiske, Bertram L

AU - Wright, Jackson

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AU - Greene, Tom

AU - Levin, Adeera

AU - Djurdjev, Ognjenka

AU - Wheeler, David C

AU - Landray, Martin J

AU - Townend, John N

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AU - Clark, Laura E

AU - Macleod, Alison

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AU - Ali, Tariq

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AU - Prescott, Gordon J

AU - Smith, David H

AU - Weinstein, Jessica R

AU - Johnson, Eric S

AU - Thorp, Micah L

AU - Wetzels, Jack F

AU - Blankestijn, P J

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AU - Sarnak, Mark

AU - Beck, Gerald

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AU - Froissart, Marc

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KW - adult

KW - aged

KW - albuminuria

KW - biological markers

KW - chi-square distribution

KW - cohort studies

KW - creatine

KW - disease progression

KW - female

KW - glomerular filtration rate

KW - humans

KW - kidney

KW - kidney diseases

KW - kidney failure, chronic

KW - male

KW - middle aged

KW - predictive value of tests

KW - prognosis

KW - proportional hazards models

KW - regression analysis

KW - risk assessment

KW - risk factors

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DO - 10.1038/ki.2010.550

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VL - 79

SP - 1331

EP - 1340

JO - Kidney International

JF - Kidney International

SN - 0085-2538

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ER -