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Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis

Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis
Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis
OBJECTIVE: To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease.

DESIGN: Random effects meta-analysis using pooled individual participant data.

SETTING: 46 cohorts from Europe, North and South America, Asia, and Australasia.

PARTICIPANTS: 2,051,158 participants (54% women) from general population cohorts (n=1,861,052), high risk cohorts (n=151,494), and chronic kidney disease cohorts (n=38,612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ? 50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (mg/g).

RESULTS: Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (P(interaction)<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (P(interaction)<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk.

CONCLUSIONS: Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.
0959-8138
f324
Nitsch, D.
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Grams, M.
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Sang, Y.
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Black, C.
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Cirillo, M.
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Djurdjev, O.
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Iseki, K.
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Jassal, S.K.
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Kimm, H.
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Kronenberg, F.
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Oien, C.M.
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Levey, A.S.
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Levin, A.
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Woodward, M.
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Hemmelgarn, B.R.
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Roderick, Paul J.
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Chronic Kidney Disease Prognosis Consortium
Nitsch, D.
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Grams, M.
885bacef-2c01-426a-add1-38df8b627ccd
Sang, Y.
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Black, C.
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Cirillo, M.
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Djurdjev, O.
a1611fec-8ce6-44cb-9a81-3f2f48e6fc2e
Iseki, K.
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Jassal, S.K.
de814c3b-3688-4b72-a7e2-49a754beb4be
Kimm, H.
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Kronenberg, F.
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Oien, C.M.
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Levey, A.S.
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Levin, A.
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Woodward, M.
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Hemmelgarn, B.R.
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Roderick, Paul J.
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Nitsch, D., Grams, M., Sang, Y., Black, C., Cirillo, M., Djurdjev, O., Iseki, K., Jassal, S.K., Kimm, H., Kronenberg, F., Oien, C.M., Levey, A.S., Levin, A., Woodward, M., Hemmelgarn, B.R. and Roderick, Paul J. , Chronic Kidney Disease Prognosis Consortium (2013) Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis. BMJ, 346, f324. (doi:10.1136/bmj.f324). (PMID:23360717)

Record type: Article

Abstract

OBJECTIVE: To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease.

DESIGN: Random effects meta-analysis using pooled individual participant data.

SETTING: 46 cohorts from Europe, North and South America, Asia, and Australasia.

PARTICIPANTS: 2,051,158 participants (54% women) from general population cohorts (n=1,861,052), high risk cohorts (n=151,494), and chronic kidney disease cohorts (n=38,612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ? 50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (mg/g).

RESULTS: Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (P(interaction)<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (P(interaction)<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk.

CONCLUSIONS: Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.

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Published date: 29 January 2013
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 350101
URI: https://eprints.soton.ac.uk/id/eprint/350101
ISSN: 0959-8138
PURE UUID: 26af4a73-7d75-4b2c-94bc-2e1cf0166c71
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 18 Mar 2013 15:09
Last modified: 06 Jun 2018 13:05

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Contributors

Author: D. Nitsch
Author: M. Grams
Author: Y. Sang
Author: C. Black
Author: M. Cirillo
Author: O. Djurdjev
Author: K. Iseki
Author: S.K. Jassal
Author: H. Kimm
Author: F. Kronenberg
Author: C.M. Oien
Author: A.S. Levey
Author: A. Levin
Author: M. Woodward
Author: B.R. Hemmelgarn

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