Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis.
To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease.



Random effects meta-analysis using pooled individual participant data.



46 cohorts from Europe, North and South America, Asia, and Australasia.



2,051,158 participants (54% women) from general population cohorts (n=1,861,052), high risk cohorts (n=151,494), and chronic kidney disease cohorts (n=38,612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥ 50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (mg/g).



Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (P(interaction)<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (P(interaction)<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk.



Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Dorothea
D
Nitsch
Morgan
M
Grams
Yingying
Y
Sang
Corri
C
Black
Massimo
M
Cirillo
Ognjenka
O
Djurdjev
Kunitoshi
K
Iseki
Simerjot K
SK
Jassal
Heejin
H
Kimm
Florian
F
Kronenberg
Cecilia M
CM
Oien
Andrew S
AS
Levey
Adeera
A
Levin
Mark
M
Woodward
Brenda R
BR
Hemmelgarn
D000419:Albuminuria / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D005260:Female; D014943:Global Health; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors