title: The impacts of albuminuria and low eGFR on the risk of cardiovascular death, all-cause mortality, and renal events in diabetic patients: meta-analysis.
abstract: BACKGROUND
  Precise effects of albuminuria and low estimated glomerular filtration rate (eGFR) on cardiovascular mortality, all-cause mortality, and renal events in diabetic patients are uncertain.
  
  
  METHODS
  A systematic review was conducted of the literature through MEDLINE, EMBASE, and CINHAL from 1950 to December 2010. Cohort studies of diabetic patients providing adjusted relative risk (RR) of albuminuria and eGFR for risks of cardiovascular mortality, all-cause mortality, and renal events were selected. Two reviewers screened abstracts and full papers of each study using standardized protocol.
  
  
  RESULTS
  We identified 31 studies fulfilling the criteria from 6546 abstracts. With regard to the risk of cardiovascular mortality, microalbuminuria (RR 1.76, 95%CI 1.38-2.25) and macroalbuminuria (RR 2.96 95%CI 2.44-3.60) were significant risk factors compared to normoalbuminuria. The same trends were seen in microalbuminuria (RR 1.60, 95%CI 1.42-1.81), and macroalbuminuria (RR 2.64, 95%CI 2.13-3.27) for the risk of all-cause mortality, and also in microalbuminuria (RR 3.21, 95%CI 2.05-5.02) and macroalbuminuria (RR 11.63, 95%CI 5.68-23.83) for the risk of renal events. The magnitudes of relative risks associated with low eGFR along with albuminuria were almost equal to multiplying each risk rate of low eGFR and albuminuria. No significant factors were found by investigating potential sources of heterogeneity using subgroup analysis.
  
  
  CONCLUSIONS
  High albuminuria and low eGFR are relevant risk factors in diabetic patients. Albuminuria and low eGFR may be independent of each other. To evaluate the effects of low eGFR, intervention, or race, appropriately designed studies are needed.
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Toyama
authors.forename: Kengo
authors.initials: K
authors.lastname: Furuichi
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Miho
authors.initials: M
authors.lastname: Shimizu
authors.forename: Akinori
authors.initials: A
authors.lastname: Hara
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Iwata
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
authors.forename: Takashi
authors.initials: T
authors.lastname: Wada
mesh_terms: D000419:Albuminuria / Q000150:complications*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology / Q000652:urine; D048909:Diabetes Complications / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology / Q000652:urine; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D012306:Risk