Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts

Brad C. Astor, Kunihiro Matsushita, Ron T. Gansevoort, Marije Van Der Velde, Mark Woodward, Andrew S. Levey, Paul E De Jong, Josef Coresh, Meguid El-Nahas, Kai Uwe Eckardt, Bertram L. Kasiske, Jackson Wright, Larry Appel, Tom Greene, Adeera Levin, Ognjenka Djurdjev, David C. Wheeler, Martin J. Landray, John N. Townend, Jonathan EmbersonLaura E. Clark, Alison MacLeod, Angharad Marks, Tariq Ali, Nicholas Fluck, Gordon Prescott, David H. Smith, Jessica R. Weinstein, Eric S. Johnson, Micah L. Thorp, Jack F. Wetzels, P. J. Blankestijn, A. D. Van Zuilen, Vandana Menon, Mark Sarnak, Gerald Beck, Florian Kronenberg, Barbara Kollerits, Marc Froissart, Benedicte Stengel, Marie Metzger, Giuseppe Remuzzi, Piero Ruggenenti, Annalisa Perna, H. J Lambers Heerspink, Barry Brenner, Dick De Zeeuw, Peter Rossing, Hans Henrik Parving, Priscilla Auguste, Kasper Veldhuis, Yaping Wang, Laura Camarata, Beverly Thomas, Tom Manley

Research output: Contribution to journalArticlepeer-review

422 Scopus citations

Abstract

We studied here the independent associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in individuals with chronic kidney disease (CKD). We performed a collaborative meta-analysis of 13 studies totaling 21,688 patients selected for CKD of diverse etiology. After adjustment for potential confounders and albuminuria, we found that a 15 ml/min per 1.73 m 2 lower eGFR below a threshold of 45 ml/min per 1.73 m 2 was significantly associated with mortality and ESRD (pooled hazard ratios (HRs) of 1.47 and 6.24, respectively). There was significant heterogeneity between studies for both HR estimates. After adjustment for risk factors and eGFR, an eightfold higher albumin- or protein-to-creatinine ratio was significantly associated with mortality (pooled HR 1.40) without evidence of significant heterogeneity and with ESRD (pooled HR 3.04), with significant heterogeneity between HR estimates. Lower eGFR and more severe albuminuria independently predict mortality and ESRD among individuals selected for CKD, with the associations stronger for ESRD than for mortality. Thus, these relationships are consistent with CKD stage classifications based on eGFR and suggest that albuminuria provides additional prognostic information among individuals with CKD.

Original languageEnglish (US)
Pages (from-to)1331-1340
Number of pages10
JournalKidney international
Volume79
Issue number12
DOIs
StatePublished - Jun 2011

Bibliographical note

Funding Information:
The CKD Prognosis Consortium is supported by Kidney Disease: Improving Global Outcomes (KDIGO) and the US National Kidney Foundation. The meta-analyses were conducted jointly at The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA and the University Medical Center Groningen, Groningen, The Netherlands, and were supported by the US National Kidney Foundation and the Dutch Kidney Foundation, respectively. KDIGO hosted the 2009 meeting of collaborators.

Keywords

  • albuminuria
  • chronic kidney disease
  • epidemiology and outcomes

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