title: Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis.
abstract: BACKGROUND
  Hypertension is the most prevalent comorbidity in individuals with chronic kidney disease. However, whether the association of the kidney disease measures, estimated glomerular filtration rate (eGFR) and albuminuria, with mortality or end-stage renal disease (ESRD) differs by hypertensive status 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 ESRD associated with eGFR and albuminuria in individuals with and without hypertension.
  
  
  RESULTS
  We analysed data for 45 cohorts (25 general population, seven high-risk, and 13 chronic kidney disease) with 1,127,656 participants, 364,344 of whom had hypertension. Low eGFR and high albuminuria were associated with mortality irrespective of hypertensive status in the general population and high-risk cohorts. All-cause mortality risk was 1·1-1·2 times higher in individuals with hypertension than in those without hypertension at preserved eGFR. A steeper relative risk gradient in individuals without hypertension than in those with hypertension at eGFR range 45-75 mL/min per 1·73 m(2) led to much the same mortality risk at lower eGFR. With a reference eGFR of 95 mL/min per 1·73 m(2) in each group to explicitly assess interaction, adjusted HR for all-cause mortality at eGFR 45 mL/min per 1·73 m(2) was 1·77 (95% CI 1·57-1·99) in individuals without hypertension versus 1·24 (1·11-1·39) in those with hypertension (p for overall interaction=0·0003). Similarly, for albumin-creatinine ratio of 300 mg/g (vs 5 mg/g), HR was 2·30 (1·98-2·68) in individuals without hypertension versus 2·08 (1·84-2·35) in those with hypertension (p for overall interaction=0·019). We recorded much the same results for cardiovascular mortality. The associations of eGFR and albuminuria with ESRD, however, did not differ by hypertensive status. Results for chronic kidney disease cohorts were similar to those for general and high-risk population cohorts.
  
  
  CONCLUSIONS
  Chronic kidney disease should be regarded as at least an equally relevant risk factor for mortality and ESRD in individuals without hypertension as it is in those with hypertension.
  
  
  BACKGROUND
  US National Kidney Foundation.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Bakhtawar K
authors.initials: BK
authors.lastname: Mahmoodi
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Massimo
authors.initials: M
authors.lastname: Cirillo
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamashita
authors.forename: Luxia
authors.initials: L
authors.lastname: Zhang
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002423:Cause of Death; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000503:physiopathology / Q000652:urine; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000652:urine; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors