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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.
Kidney Int 2011; 79(12):1331-40KI

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 m² lower eGFR below a threshold of 45 ml/min per 1.73 m² 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.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21289598

Citation

Astor, Brad C., et al. "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." Kidney International, vol. 79, no. 12, 2011, pp. 1331-40.
Astor BC, Matsushita K, Gansevoort RT, et al. 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. Kidney Int. 2011;79(12):1331-40.
Astor, B. C., Matsushita, K., Gansevoort, R. T., van der Velde, M., Woodward, M., Levey, A. S., ... Manley, T. (2011). 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. Kidney International, 79(12), pp. 1331-40. doi:10.1038/ki.2010.550.
Astor BC, et al. 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. Kidney Int. 2011;79(12):1331-40. PubMed PMID: 21289598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Astor,Brad C, AU - Matsushita,Kunihiro, AU - Gansevoort,Ron T, AU - van der Velde,Marije, AU - Woodward,Mark, AU - Levey,Andrew S, AU - Jong,Paul E de, AU - Coresh,Josef, AU - ,, AU - Astor,Brad C, AU - Matsushita,Kunihiro, AU - Gansevoort,Ron T, AU - van der Velde,Marije, AU - Woodward,Mark, AU - Levey,Andrew S, AU - de Jong,Paul E, AU - Coresh,Josef, AU - El-Nahas,Meguid, AU - Eckardt,Kai-Uwe, AU - Kasiske,Bertram L, AU - Wright,Jackson, AU - Appel,Larry, AU - Greene,Tom, AU - Levin,Adeera, AU - Djurdjev,Ognjenka, AU - Wheeler,David C, AU - Landray,Martin J, AU - Townend,John N, AU - Emberson,Jonathan, AU - Clark,Laura E, AU - Macleod,Alison, AU - Marks,Angharad, AU - Ali,Tariq, AU - Fluck,Nicholas, AU - Prescott,Gordon, AU - Smith,David H, AU - Weinstein,Jessica R, AU - Johnson,Eric S, AU - Thorp,Micah L, AU - Wetzels,Jack F, AU - Blankestijn,P J, AU - van Zuilen,A D, AU - Menon,Vandana, AU - Sarnak,Mark, AU - Beck,Gerald, AU - Kronenberg,Florian, AU - Kollerits,Barbara, AU - Froissart,Marc, AU - Stengel,Benedicte, AU - Metzger,Marie, AU - Remuzzi,Giuseppe, AU - Ruggenenti,Piero, AU - Perna,Annalisa, AU - Heerspink,H J Lambers, AU - Brenner,Barry, AU - de Zeeuw,Dick, AU - Rossing,Peter, AU - Parving,Hans-Henrik, AU - Auguste,Priscilla, AU - Veldhuis,Kasper, AU - Wang,Yaping, AU - Camarata,Laura, AU - Thomas,Beverly, AU - Manley,Tom, Y1 - 2011/02/02/ PY - 2011/2/4/entrez PY - 2011/2/4/pubmed PY - 2011/9/17/medline SP - 1331 EP - 40 JF - Kidney international JO - Kidney Int. VL - 79 IS - 12 N2 - 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 m² lower eGFR below a threshold of 45 ml/min per 1.73 m² 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. SN - 1523-1755 UR - https://www.unboundmedicine.com/medline/citation/21289598/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)54741-8 DB - PRIME DP - Unbound Medicine ER -