title: A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white).
  
  
  METHODS
  Collaborative meta-analysis.
  
  
  METHODS
  8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants).
  
  
  METHODS
  Available eGFR, ACR, and 50 or more AKI events.
  
  
  METHODS
  Age, sex, race, eGFR, urine ACR, and interactions.
  
  
  RESULTS
  Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.
  
  
  RESULTS
  16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR.
  
  
  CONCLUSIONS
  Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code.
  
  
  CONCLUSIONS
  Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.
authors.affiliation: Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.affiliation: Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.affiliation: Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea.
authors.forename: Heejin
authors.initials: H
authors.lastname: Kimm
authors.affiliation: Memphis Veterans Affairs Medical Center, Memphis, TN.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Naimark
authors.affiliation: Norwegian University of Science and Technology and St Olavs University Hospital, Trondheim, Norway.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Oien
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.affiliation: Inserm U1018, CESP Centre for Research in Epidemiology and Population Health and UMRS 1018, Paris-Sud University, Villejuif, France.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Stengel
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D044469:Racial Groups / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D017678:Sex Distribution; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Chronic Kidney Disease Prognosis Consortium; Estimated glomerular filtration rate (eGFR); acute kidney injury (AKI); acute renal failure (ARF); age; albumin-creatinine ratio (ACR); albuminuria; meta-analysis; proteinuria; race/ethnicity; renal function; sex