title: 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.
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.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Marije
authors.initials: M
authors.lastname: van der Velde
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Paul E de
authors.initials: PE
authors.lastname: Jong
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Marije
authors.initials: M
authors.lastname: van der Velde
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Meguid
authors.initials: M
authors.lastname: El-Nahas
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: Jackson
authors.initials: J
authors.lastname: Wright
authors.forename: Larry
authors.initials: L
authors.lastname: Appel
authors.forename: Tom
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authors.lastname: Greene
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Ognjenka
authors.initials: O
authors.lastname: Djurdjev
authors.forename: David C
authors.initials: DC
authors.lastname: Wheeler
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Landray
authors.forename: John N
authors.initials: JN
authors.lastname: Townend
authors.forename: Jonathan
authors.initials: J
authors.lastname: Emberson
authors.forename: Laura E
authors.initials: LE
authors.lastname: Clark
authors.forename: Alison
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authors.lastname: Macleod
authors.forename: Angharad
authors.initials: A
authors.lastname: Marks
authors.forename: Tariq
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authors.lastname: Ali
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fluck
authors.forename: Gordon
authors.initials: G
authors.lastname: Prescott
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Weinstein
authors.forename: Eric S
authors.initials: ES
authors.lastname: Johnson
authors.forename: Micah L
authors.initials: ML
authors.lastname: Thorp
authors.forename: Jack F
authors.initials: JF
authors.lastname: Wetzels
authors.forename: P J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: A D
authors.initials: AD
authors.lastname: van Zuilen
authors.forename: Vandana
authors.initials: V
authors.lastname: Menon
authors.forename: Mark
authors.initials: M
authors.lastname: Sarnak
authors.forename: Gerald
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authors.lastname: Beck
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
authors.forename: Barbara
authors.initials: B
authors.lastname: Kollerits
authors.forename: Marc
authors.initials: M
authors.lastname: Froissart
authors.forename: Benedicte
authors.initials: B
authors.lastname: Stengel
authors.forename: Marie
authors.initials: M
authors.lastname: Metzger
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
authors.forename: Piero
authors.initials: P
authors.lastname: Ruggenenti
authors.forename: Annalisa
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authors.lastname: Perna
authors.forename: H J Lambers
authors.initials: HJ
authors.lastname: Heerspink
authors.forename: Barry
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authors.lastname: Brenner
authors.forename: Dick
authors.initials: D
authors.lastname: de Zeeuw
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Priscilla
authors.initials: P
authors.lastname: Auguste
authors.forename: Kasper
authors.initials: K
authors.lastname: Veldhuis
authors.forename: Yaping
authors.initials: Y
authors.lastname: Wang
authors.forename: Laura
authors.initials: L
authors.lastname: Camarata
authors.forename: Beverly
authors.initials: B
authors.lastname: Thomas
authors.forename: Tom
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authors.lastname: Manley
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003401:Creatine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003401:Creatine