title: Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts.
abstract: Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m², but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m² were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.
authors.affiliation: Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Marije
authors.initials: M
authors.lastname: van der Velde
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Andrew
authors.initials: A
authors.lastname: Levey
authors.forename: Paul
authors.initials: P
authors.lastname: de Jong
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Marije
authors.initials: M
authors.lastname: van der Velde
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
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: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Andrew
authors.initials: A
authors.lastname: Levey
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: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Stephen
authors.initials: S
authors.lastname: Macmahon
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.forename: Frank
authors.initials: F
authors.lastname: Sacks
authors.forename: Gary
authors.initials: G
authors.lastname: Curhan
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Shu-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: K P
authors.initials: KP
authors.lastname: Hawaii Cohort
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lee
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.forename: James
authors.initials: J
authors.lastname: Neaton
authors.forename: Ken
authors.initials: K
authors.lastname: Svendsen
authors.forename: Johannes F E
authors.initials: JF
authors.lastname: Mann
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: Peggy
authors.initials: P
authors.lastname: Gao
authors.forename: Robert G
authors.initials: RG
authors.lastname: Nelson
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Bilo
authors.forename: Hanneke
authors.initials: H
authors.lastname: Joosten
authors.forename: Nanno
authors.initials: N
authors.lastname: Kleefstra
authors.forename: K H
authors.initials: KH
authors.lastname: Groenier
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
authors.initials: T
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; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; 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; 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