title: Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.
abstract: BACKGROUND
  Chronic kidney disease is characterised by low estimated glomerular filtration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modified by diabetes is unknown.
  
  
  METHODS
  We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and end-stage renal disease (ESRD) associated with eGFR and albuminuria in individuals with and without diabetes.
  
  
  RESULTS
  We analysed data for 1,024,977 participants (128,505 with diabetes) from 30 general population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and high-risk cohorts with data for all-cause mortality, 75,306 deaths occurred during a mean follow-up of 8·5 years (SD 5·0). In the 23 studies with data for cardiovascular mortality, 21,237 deaths occurred from cardiovascular disease during a mean follow-up of 9·2 years (SD 4·9). In the general and high-risk cohorts, mortality risks were 1·2-1·9 times higher for participants with diabetes than for those without diabetes across the ranges of eGFR and albumin-to-creatinine ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes groups, HR of mortality outcomes according to lower eGFR and higher ACR were much the same in participants with and without diabetes (eg, for all-cause mortality at eGFR 45 mL/min per 1·73 m(2) [vs 95 mL/min per 1·73 m(2)], HR 1·35; 95% CI 1·18-1·55; vs 1·33; 1·19-1·48 and at ACR 30 mg/g [vs 5 mg/g], 1·50; 1·35-1·65 vs 1·52; 1·38-1·67). The overall interactions were not significant. We identified much the same findings for ESRD in the chronic kidney disease cohorts.
  
  
  CONCLUSIONS
  Despite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes.
  
  
  BACKGROUND
  US National Kidney Foundation.
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, Center for Population Studies Framingham, MA, USA.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Henk J G
authors.initials: HJ
authors.lastname: Bilo
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Hiddo J Lambers
authors.initials: HJ
authors.lastname: Heerspink
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lee
authors.forename: Robert M
authors.initials: RM
authors.lastname: Perkins
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Toshimi
authors.initials: T
authors.lastname: Sairenchi
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vassalotti
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Chi-Pang
authors.initials: CP
authors.lastname: Wen
authors.forename: Robert G
authors.initials: RG
authors.lastname: Nelson
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000401:mortality / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000503:physiopathology / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000652:urine; D008297:Male; D008875:Middle Aged; D012307:Risk Factors