TY - JOUR
T1 - Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality.
T2 - A collaborative meta-analysis of high-risk population cohorts
AU - Van Der Velde, Marije
AU - Matsushita, Kunihiro
AU - Coresh, Josef
AU - Astor, Brad C.
AU - Woodward, Mark
AU - Levey, Andrew
AU - De Jong, Paul
AU - Gansevoort, Ron T.
AU - Chronic Kidney Disease Prognosis Consortium
AU - Chalmers, John
AU - El-Nahas, Meguid
AU - Eckardt, Kai Uwe
AU - Kasiske, Bertram L.
AU - Ninomiya, Toshiharu
AU - MacMahon, Stephen
AU - Tonelli, Marcello
AU - Hemmelgarn, Brenda
AU - Sacks, Frank
AU - Curhan, Gary
AU - Collins, Allan J.
AU - Li, Suying
AU - Chen, Shu Cheng
AU - Hawaii Cohort, K. P.
AU - Lee, Brian J.
AU - Ishani, Areef
AU - Neaton, James
AU - Svendsen, Ken
AU - Mann, Johannes F.E.
AU - Yusuf, Salim
AU - Teo, Koon K.
AU - Gao, Peggy
AU - Nelson, Robert G.
AU - Knowler, William C.
AU - Bilo, Henk J.
AU - Joosten, Hanneke
AU - Kleefstra, Nanno
AU - Groenier, K. H.
AU - Auguste, Priscilla
AU - Veldhuis, Kasper
AU - Wang, Yaping
AU - Camarata, Laura
AU - Thomas, Beverly
AU - Manley, Tom
PY - 2011/6
Y1 - 2011/6
N2 - Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m 2, but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m 2 were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.
AB - Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m 2, but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m 2 were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.
KW - albumin-to-creatinine ratio (albuminuria)
KW - all-cause mortality
KW - cardiovascular mortality
KW - eGFR (kidney function)
KW - high-risk cohorts
KW - meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=79957858617&partnerID=8YFLogxK
U2 - 10.1038/ki.2010.536
DO - 10.1038/ki.2010.536
M3 - Review article
AN - SCOPUS:79957858617
VL - 79
SP - 1331
EP - 1340
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 12
ER -