The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

Age and association of kidney measures with mortality and end-stage renal disease

Age and association of kidney measures with mortality and end-stage renal disease
Age and association of kidney measures with mortality and end-stage renal disease
CONTEXT: Chronic kidney disease (CKD) is prevalent in older individuals, but the risk implications of low estimated glomerular filtration rate (eGFR) and high albuminuria across the full age range are controversial.

OBJECTIVE: To evaluate possible effect modification (interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks.

DESIGN, SETTING, AND PARTICIPANTS: Individual-level meta-analysis including 2,051,244 participants from 33 general population or high-risk (of vascular disease) cohorts and 13 CKD cohorts from Asia, Australasia, Europe, and North/South America, conducted in 1972-2011 with a mean follow-up time of 5.8 years (range, 0-31 years).

MAIN OUTCOME MEASURES: Hazard ratios (HRs) of mortality and end-stage renal disease (ESRD) according to eGFR and albuminuria were meta-analyzed across age categories after adjusting for sex, race, cardiovascular disease, diabetes, systolic blood pressure, cholesterol, body mass index, and smoking. Absolute risks were estimated using HRs and average incidence rates.

RESULTS: Mortality (112,325 deaths) and ESRD (8411 events) risks were higher at lower eGFR and higher albuminuria in every age category. In general and high-risk cohorts, relative mortality risk for reduced eGFR decreased with increasing age; eg, adjusted HRs at an eGFR of 45 mL/min/1.73 m2 vs 80 mL/min/1.73 m2 were 3.50 (95% CI, 2.55-4.81), 2.21 (95% CI, 2.02-2.41), 1.59 (95% CI, 1.42-1.77), and 1.35 (95% CI, 1.23-1.48) in age categories 18-54, 55-64, 65-74, and ?75 years, respectively (P <.05 for age interaction). Absolute risk differences for the same comparisons were higher at older age (9.0 [95% CI, 6.0-12.8], 12.2 [95% CI, 10.3-14.3], 13.3 [95% CI, 9.0-18.6], and 27.2 [95% CI, 13.5-45.5] excess deaths per 1000 person-years, respectively). For increased albuminuria, reduction of relative risk with increasing age was less evident, while differences in absolute risk were higher in older age categories (7.5 [95% CI, 4.3-11.9], 12.2 [95% CI, 7.9-17.6], 22.7 [95% CI, 15.3-31.6], and 34.3 [95% CI, 19.5-52.4] excess deaths per 1000 person-years, respectively by age category, at an albumin-creatinine ratio of 300 mg/g vs 10 mg/g). In CKD cohorts, adjusted relative hazards of mortality did not decrease with age. In all cohorts, ESRD relative risks and absolute risk differences at lower eGFR or higher albuminuria were comparable across age categories.

CONCLUSIONS: Both low eGFR and high albuminuria were independently associated with mortality and ESRD regardless of age across a wide range of populations. Mortality showed lower relative risk but higher absolute risk differences at older age.
1538-3598
2349-60
Hallan, S.I.
9a49f833-2cc9-4217-aae7-c1f3206d2f74
Matsushita, K.
98326a67-abe6-4709-8b33-f7e68a668d75
Sang, Y.
26a4d9d4-da6f-4d66-a05d-c84ba38b826c
Mahmoodi, B.K.
fa5e288e-a187-4b8f-896c-f7fc046352fc
Black, C.
5b701372-b1e8-4dd0-994a-caf711fac9a8
Ishani, A.
f40859e8-2e79-4b70-bb42-d95282af5f76
Kleefstra, N.
d3b8a2ed-2e0a-4a92-8bd6-74b4cbc34f65
Naimark, D.
8224ccc9-cd45-459e-8aaf-9e27e5a7c4c0
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Tonelli, M.
eb60f888-4899-46c5-b208-e43d0dd460c7
Wetzels, J.F.
15ff6f4b-dfaf-4957-9455-0daf0c32575d
Astor, B.C.
3065715d-64d0-4656-aa3b-66a0c39f6fbd
Gansevoort, R.T.
0debdc6e-bcf9-4569-9ffe-76721f6462cb
Levin, A.
0d06c2ef-c05b-4408-b768-26c33fc021cb
Wen, C.P.
5a099e50-57d2-420d-8b37-4452714b85b8
Coresh, J.
2401afc6-e7cd-4098-af40-e2c04681e250
Chronic Kidney Disease Prognosis Consortium
Hallan, S.I.
9a49f833-2cc9-4217-aae7-c1f3206d2f74
Matsushita, K.
98326a67-abe6-4709-8b33-f7e68a668d75
Sang, Y.
26a4d9d4-da6f-4d66-a05d-c84ba38b826c
Mahmoodi, B.K.
fa5e288e-a187-4b8f-896c-f7fc046352fc
Black, C.
5b701372-b1e8-4dd0-994a-caf711fac9a8
Ishani, A.
f40859e8-2e79-4b70-bb42-d95282af5f76
Kleefstra, N.
d3b8a2ed-2e0a-4a92-8bd6-74b4cbc34f65
Naimark, D.
8224ccc9-cd45-459e-8aaf-9e27e5a7c4c0
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Tonelli, M.
eb60f888-4899-46c5-b208-e43d0dd460c7
Wetzels, J.F.
15ff6f4b-dfaf-4957-9455-0daf0c32575d
Astor, B.C.
3065715d-64d0-4656-aa3b-66a0c39f6fbd
Gansevoort, R.T.
0debdc6e-bcf9-4569-9ffe-76721f6462cb
Levin, A.
0d06c2ef-c05b-4408-b768-26c33fc021cb
Wen, C.P.
5a099e50-57d2-420d-8b37-4452714b85b8
Coresh, J.
2401afc6-e7cd-4098-af40-e2c04681e250

Hallan, S.I., Matsushita, K., Sang, Y., Mahmoodi, B.K., Black, C., Ishani, A., Kleefstra, N., Naimark, D., Roderick, P., Tonelli, M., Wetzels, J.F., Astor, B.C., Gansevoort, R.T., Levin, A., Wen, C.P. and Coresh, J. , Chronic Kidney Disease Prognosis Consortium (2012) Age and association of kidney measures with mortality and end-stage renal disease. JAMA, 308 (22), 2349-60. (doi:10.1001/jama.2012.16817). (PMID:23111824)

Record type: Article

Abstract

CONTEXT: Chronic kidney disease (CKD) is prevalent in older individuals, but the risk implications of low estimated glomerular filtration rate (eGFR) and high albuminuria across the full age range are controversial.

OBJECTIVE: To evaluate possible effect modification (interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks.

DESIGN, SETTING, AND PARTICIPANTS: Individual-level meta-analysis including 2,051,244 participants from 33 general population or high-risk (of vascular disease) cohorts and 13 CKD cohorts from Asia, Australasia, Europe, and North/South America, conducted in 1972-2011 with a mean follow-up time of 5.8 years (range, 0-31 years).

MAIN OUTCOME MEASURES: Hazard ratios (HRs) of mortality and end-stage renal disease (ESRD) according to eGFR and albuminuria were meta-analyzed across age categories after adjusting for sex, race, cardiovascular disease, diabetes, systolic blood pressure, cholesterol, body mass index, and smoking. Absolute risks were estimated using HRs and average incidence rates.

RESULTS: Mortality (112,325 deaths) and ESRD (8411 events) risks were higher at lower eGFR and higher albuminuria in every age category. In general and high-risk cohorts, relative mortality risk for reduced eGFR decreased with increasing age; eg, adjusted HRs at an eGFR of 45 mL/min/1.73 m2 vs 80 mL/min/1.73 m2 were 3.50 (95% CI, 2.55-4.81), 2.21 (95% CI, 2.02-2.41), 1.59 (95% CI, 1.42-1.77), and 1.35 (95% CI, 1.23-1.48) in age categories 18-54, 55-64, 65-74, and ?75 years, respectively (P <.05 for age interaction). Absolute risk differences for the same comparisons were higher at older age (9.0 [95% CI, 6.0-12.8], 12.2 [95% CI, 10.3-14.3], 13.3 [95% CI, 9.0-18.6], and 27.2 [95% CI, 13.5-45.5] excess deaths per 1000 person-years, respectively). For increased albuminuria, reduction of relative risk with increasing age was less evident, while differences in absolute risk were higher in older age categories (7.5 [95% CI, 4.3-11.9], 12.2 [95% CI, 7.9-17.6], 22.7 [95% CI, 15.3-31.6], and 34.3 [95% CI, 19.5-52.4] excess deaths per 1000 person-years, respectively by age category, at an albumin-creatinine ratio of 300 mg/g vs 10 mg/g). In CKD cohorts, adjusted relative hazards of mortality did not decrease with age. In all cohorts, ESRD relative risks and absolute risk differences at lower eGFR or higher albuminuria were comparable across age categories.

CONCLUSIONS: Both low eGFR and high albuminuria were independently associated with mortality and ESRD regardless of age across a wide range of populations. Mortality showed lower relative risk but higher absolute risk differences at older age.

This record has no associated files available for download.

More information

Published date: 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 350115
URI: http://eprints.soton.ac.uk/id/eprint/350115
ISSN: 1538-3598
PURE UUID: 3b0ff35f-f006-403c-92b4-8487a253e0c2
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 18 Mar 2013 15:18
Last modified: 26 Nov 2021 02:37

Export record

Altmetrics

Contributors

Author: S.I. Hallan
Author: K. Matsushita
Author: Y. Sang
Author: B.K. Mahmoodi
Author: C. Black
Author: A. Ishani
Author: N. Kleefstra
Author: D. Naimark
Author: P. Roderick ORCID iD
Author: M. Tonelli
Author: J.F. Wetzels
Author: B.C. Astor
Author: R.T. Gansevoort
Author: A. Levin
Author: C.P. Wen
Author: J. Coresh
Corporate Author: Chronic Kidney Disease Prognosis Consortium

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×