title: A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury.
abstract: BACKGROUND
  Diabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain.
  
  
  METHODS
  Meta-analysis of cohort studies.
  
  
  METHODS
  8 general-population (1,285,045 participants) and 5 chronic kidney disease (CKD; 79,519 participants) cohorts.
  
  
  METHODS
  Cohorts participating in the CKD Prognosis Consortium.
  
  
  METHODS
  Diabetes and hypertension status, eGFR by the 2009 CKD Epidemiology Collaboration creatinine equation, urine ACR, and interactions.
  
  
  RESULTS
  Hospitalization with AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.
  
  
  RESULTS
  During a mean follow-up of 4 years, there were 16,480 episodes of AKI in the general-population and 2,087 episodes in the CKD cohorts. Low eGFRs and high ACRs were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR of 80mL/min/1.73m(2) in nondiabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared with nondiabetic patients. The risk gradient for AKI with lower eGFRs was greater in those without diabetes than with diabetes, but similar with higher ACRs in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFRs>60mL/min/1.73m(2) than those without hypertension. However, risk gradients for AKI with both lower eGFRs and higher ACRs were greater for those without than with hypertension.
  
  
  CONCLUSIONS
  AKI identified by diagnostic code.
  
  
  CONCLUSIONS
  Lower eGFRs and higher ACRs are associated with higher risks of AKI among individuals with or without either diabetes or hypertension.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
authors.affiliation: Nephrology Department, Geisinger Medical Center, Danville, PA.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Green
authors.affiliation: University College London, London, United Kingdom.
authors.forename: David C
authors.initials: DC
authors.lastname: Wheeler
authors.affiliation: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: de Jong
authors.affiliation: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.affiliation: Division of Nephrology at Tufts Medical Center, Boston, MA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.affiliation: Division of Nephrology at Tufts Medical Center, Boston, MA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology
keywords: Chronic Kidney Disease Prognosis Consortium; Estimated glomerular filtration rate (eGFR); acute kidney injury (AKI); acute renal failure (ARF); albumin-creatine ratio (ACR); albuminuria; diabetes; hypertension; meta-analysis; renal function