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 WrightLarry 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

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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

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

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    Astor, B. C., Matsushita, K., Gansevoort, R. T., van der Velde, M., Woodward, M., Levey, A. S., Jong, P. E. D., Coresh, J., Astor, B. C., Matsushita, K., Gansevoort, R. T., van der Velde, M., Woodward, M., Levey, A. S., de Jong, P. E., Coresh, J., El-Nahas, M., Eckardt, K-U., Kasiske, B. L., ... 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