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Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis

Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
Background: Substantial controversy surrounds the use of estimated glomerular filtration rate (eGFR) and albuminuria to define chronic kidney disease and assign its stages. We undertook a meta-analysis to assess the independent and combined associations of eGFR and albuminuria with mortality.

Methods: In this collaborative meta-analysis of general population cohorts, we pooled standardised data for all-cause and cardiovascular mortality from studies containing at least 1000 participants and baseline information about eGFR and urine albumin concentrations. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause and cardiovascular mortality associated with eGFR and albuminuria, adjusted for potential confounders.

Findings: The analysis included 105 872 participants (730 577 person-years) from 14 studies with urine albumin-to-creatinine ratio (ACR) measurements and 1 128 310 participants (4 732 110 person-years) from seven studies with urine protein dipstick measurements. In studies with ACR measurements, risk of mortality was unrelated to eGFR between 75 mL/min/1·73 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2, adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05—1·32) for eGFR 60 mL/min/1·73 m2, 1·57 (1·39—1·78) for 45 mL/min/1·73 m2, and 3·14 (2·39—4·13) for 15 mL/min/1·73 m2. ACR was associated with risk of mortality linearly on the log-log scale without threshold effects. Compared with ACR 0·6 mg/mmol, adjusted HRs for all-cause mortality were 1·20 (1·15—1·26) for ACR 1·1 mg/mmol, 1·63 (1·50—1·77) for 3·4 mg/mmol, and 2·22 (1·97—2·51) for 33·9 mg/mmol. eGFR and ACR were multiplicatively associated with risk of mortality without evidence of interaction. Similar findings were recorded for cardiovascular mortality and in studies with dipstick measurements.

Interpretation: eGFR less than 60 mL/min/1·73 m2 and ACR 1·1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.

Funding: Kidney Disease: Improving Global Outcomes (KDIGO), US National Kidney Foundation, and Dutch Kidney Foundation.
0140-6736
2073-81
Matsushita, K
f3675b02-933b-486d-a79f-7f7136936b32
van der Velde, M
41eefc9a-5546-40b4-aff4-380a1508ef1b
Astor, BC
bba3872f-bc49-411d-a392-309c6045290c
Woodward, M
8868b8bc-14e8-41e0-b5b6-f726388d8c48
Levey, AS
2ad5b5a2-2b08-4aa4-8d19-d8b2f5a948e0
de Jong, PE
1fb4a6af-e777-4fe0-8aab-4bae2272ce0f
Coresh, J
3571c546-d5b0-445a-9214-0994b1db83da
Gansevoort, RT
451627a4-abb4-4560-b386-e4a8af66aeaf
Roderick, P
dbb3cd11-4c51-4844-982b-0eb30ad5085a
in Chronic Kidney Prognosis Consortium
Matsushita, K
f3675b02-933b-486d-a79f-7f7136936b32
van der Velde, M
41eefc9a-5546-40b4-aff4-380a1508ef1b
Astor, BC
bba3872f-bc49-411d-a392-309c6045290c
Woodward, M
8868b8bc-14e8-41e0-b5b6-f726388d8c48
Levey, AS
2ad5b5a2-2b08-4aa4-8d19-d8b2f5a948e0
de Jong, PE
1fb4a6af-e777-4fe0-8aab-4bae2272ce0f
Coresh, J
3571c546-d5b0-445a-9214-0994b1db83da
Gansevoort, RT
451627a4-abb4-4560-b386-e4a8af66aeaf
Roderick, P
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Matsushita, K, van der Velde, M, Astor, BC, Woodward, M, Levey, AS, de Jong, PE, Coresh, J, Gansevoort, RT and Roderick, P , in Chronic Kidney Prognosis Consortium (2010) Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet, 375 (9731), 2073-81. (doi:10.1016/S0140-6736(10)60674-5).

Record type: Article

Abstract

Background: Substantial controversy surrounds the use of estimated glomerular filtration rate (eGFR) and albuminuria to define chronic kidney disease and assign its stages. We undertook a meta-analysis to assess the independent and combined associations of eGFR and albuminuria with mortality.

Methods: In this collaborative meta-analysis of general population cohorts, we pooled standardised data for all-cause and cardiovascular mortality from studies containing at least 1000 participants and baseline information about eGFR and urine albumin concentrations. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause and cardiovascular mortality associated with eGFR and albuminuria, adjusted for potential confounders.

Findings: The analysis included 105 872 participants (730 577 person-years) from 14 studies with urine albumin-to-creatinine ratio (ACR) measurements and 1 128 310 participants (4 732 110 person-years) from seven studies with urine protein dipstick measurements. In studies with ACR measurements, risk of mortality was unrelated to eGFR between 75 mL/min/1·73 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2, adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05—1·32) for eGFR 60 mL/min/1·73 m2, 1·57 (1·39—1·78) for 45 mL/min/1·73 m2, and 3·14 (2·39—4·13) for 15 mL/min/1·73 m2. ACR was associated with risk of mortality linearly on the log-log scale without threshold effects. Compared with ACR 0·6 mg/mmol, adjusted HRs for all-cause mortality were 1·20 (1·15—1·26) for ACR 1·1 mg/mmol, 1·63 (1·50—1·77) for 3·4 mg/mmol, and 2·22 (1·97—2·51) for 33·9 mg/mmol. eGFR and ACR were multiplicatively associated with risk of mortality without evidence of interaction. Similar findings were recorded for cardiovascular mortality and in studies with dipstick measurements.

Interpretation: eGFR less than 60 mL/min/1·73 m2 and ACR 1·1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.

Funding: Kidney Disease: Improving Global Outcomes (KDIGO), US National Kidney Foundation, and Dutch Kidney Foundation.

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More information

e-pub ahead of print date: 18 May 2010
Published date: June 2010
Organisations: Community Clinical Sciences, Primary Care & Population Sciences

Identifiers

Local EPrints ID: 156677
URI: http://eprints.soton.ac.uk/id/eprint/156677
ISSN: 0140-6736
PURE UUID: 2d4bfebc-fe6b-40d0-9d22-10097fb48f34
ORCID for P Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 01 Jun 2010 15:25
Last modified: 10 Jan 2022 02:37

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Contributors

Author: K Matsushita
Author: M van der Velde
Author: BC Astor
Author: M Woodward
Author: AS Levey
Author: PE de Jong
Author: J Coresh
Author: RT Gansevoort
Author: P Roderick ORCID iD
Corporate Author: in Chronic Kidney Prognosis Consortium

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