title: Risk Factors for Development and Progression of Chronic Kidney Disease: A Systematic Review and Exploratory Meta-Analysis.
abstract: The risk factors influencing the natural course of chronic kidney disease (CKD) are complex and heterogeneous, and few systematic reviews to date have focused on this issue. The aim of the study is to identify the risk factors for disease development and progression in each stage of CKD. We conducted electronic literature searches of PubMed, MEDLINE, Scopus, and the Cochrane Library up to October 15, 2012, for observational studies evaluating the risk factors on the development or progression of CKD. Eligible studies should have collected repeated information that could evaluate changes in renal function. Extracted information from all the included studies was synthesized narratively. Quality assessments were performed using the Newcastle-Ottawa Scale. An exploratory random-effects meta-analysis was performed where feasible to pool effect sizes across studies for a specific risk factor in a specific outcome. We identified 38 cohort studies and 2 case-control studies from 40 articles, with a total of 318,898 participants from 14 countries. The follow-up duration ranged from 1.5 to 16 years. The majority of the included studies were of high quality. The baseline CKD stages of the included studies ranged from normal to later stages, and only 19 studies could be classified into a specific range of CKD stages during follow-up. Three risk factors from studies of the same baseline and follow-up CKD stages were eligible for the exploratory meta-analysis, including male sex, substantial proteinuria, and diabetes. The hazard ratios for the progression from CKD stages 3-5 to end-stage renal disease (ESRD) were 1.37 (95% confidence interval 1.17-1.62), 1.64 (1.01-2.66), and 1.16 (0.98-1.38) for male sex, substantial proteinuria, and diabetes, respectively. In conclusion, our analyses comprehensively summarize the initiating and perpetuating factors for CKD. Male sex and substantial proteinuria are significant perpetuating factors for the progression from late stage CKD to ESRD, and diabetes may play a minor role for the outcome of ESRD among patients with later stages of CKD.
authors.affiliation: From the Department of Internal Medicine (W-CT, H-YW, Y-SP), Far Eastern Memorial Hospital, New Taipei City; Institute of Epidemiology and Preventive Medicine (W-CT, H-YW, K-LC), College of Public Health, National Taiwan University; Department of Internal Medicine (H-YW, Y-SP, M-SW, K-YH, K-DW, T-SC, K-LC); Department of Dermatology (M-JK), National Taiwan University Hospital and College of Medicine; and Department of Dermatology (M-JK), Taipei City Hospital, Taipei, Taiwan.
authors.forename: Wan-Chuan
authors.initials: WC
authors.lastname: Tsai
authors.forename: Hon-Yen
authors.initials: HY
authors.lastname: Wu
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
authors.forename: Mei-Ju
authors.initials: MJ
authors.lastname: Ko
authors.forename: Ming-Shiou
authors.initials: MS
authors.lastname: Wu
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
mesh_terms: D003928:Diabetic Nephropathies / Q000453:epidemiology; D018450:Disease Progression; D006801:Humans; D011507:Proteinuria / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors