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Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis

The Lancet (British edition), 2010-06, Vol.375 (9731), p.2073-2081 [Peer Reviewed Journal]

Elsevier Ltd ;2010 Elsevier Ltd ;2015 INIST-CNRS ;Copyright 2010 Elsevier Ltd. All rights reserved. ;Copyright Elsevier Limited Jun 12-Jun 18, 2010 ;ISSN: 0140-6736 ;ISSN: 1474-547X ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(10)60674-5 ;PMID: 20483451 ;CODEN: LANCAO

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Title:
Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
Author: Matsushita, Kunihiro ; van der Velde, Marije ; Astor, Brad C ; Woodward, Mark ; Levey, Andrew S ; de Jong, Paul E ; Coresh, Josef ; Gansevoort, Ron T
Subjects: Aged ; Albuminuria - complications ; Associated diseases and complications ; Biological and medical sciences ; Cardiovascular disease ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - physiopathology ; Chronic Disease ; Creatinine - urine ; Diabetes ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Female ; General aspects ; Glomerular Filtration Rate ; Humans ; Internal Medicine ; Kidney diseases ; Kidney Diseases - physiopathology ; Kidneys ; Male ; Medical sciences ; Middle Aged ; Mortality ; Nephrology. Urinary tract diseases ; Older people ; Proportional Hazards Models ; Studies ; Systematic review ; Urinary system involvement in other diseases. Miscellaneous
Is Part Of: The Lancet (British edition), 2010-06, Vol.375 (9731), p.2073-2081
Description: Summary Background Substantial controversy surrounds the use of estimated glomerular filtration rate (eGFR) and albuminuria to define chronic kidney disease and assign its stages. We undertook a meta-analysis to assess the independent and combined associations of eGFR and albuminuria with mortality. Methods In this collaborative meta-analysis of general population cohorts, we pooled standardised data for all-cause and cardiovascular mortality from studies containing at least 1000 participants and baseline information about eGFR and urine albumin concentrations. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause and cardiovascular mortality associated with eGFR and albuminuria, adjusted for potential confounders. Findings The analysis included 105 872 participants (730 577 person-years) from 14 studies with urine albumin-to-creatinine ratio (ACR) measurements and 1 128 310 participants (4 732 110 person-years) from seven studies with urine protein dipstick measurements. In studies with ACR measurements, risk of mortality was unrelated to eGFR between 75 mL/min/1·73 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2 , adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05–1·32) for eGFR 60 mL/min/1·73 m2 , 1·57 (1·39–1·78) for 45 mL/min/1·73 m2 , and 3·14 (2·39–4·13) for 15 mL/min/1·73 m2 . ACR was associated with risk of mortality linearly on the log-log scale without threshold effects. Compared with ACR 0·6 mg/mmol, adjusted HRs for all-cause mortality were 1·20 (1·15–1·26) for ACR 1·1 mg/mmol, 1·63 (1·50–1·77) for 3·4 mg/mmol, and 2·22 (1·97–2·51) for 33·9 mg/mmol. eGFR and ACR were multiplicatively associated with risk of mortality without evidence of interaction. Similar findings were recorded for cardiovascular mortality and in studies with dipstick measurements. Interpretation eGFR less than 60 mL/min/1·73 m2 and ACR 1·1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease. Funding Kidney Disease: Improving Global Outcomes (KDIGO), US National Kidney Foundation, and Dutch Kidney Foundation.
Publisher: Kidlington: Elsevier Ltd
Language: English
Identifier: ISSN: 0140-6736
ISSN: 1474-547X
EISSN: 1474-547X
DOI: 10.1016/S0140-6736(10)60674-5
PMID: 20483451
CODEN: LANCAO
Source: ProQuest One Psychology
MEDLINE
ProQuest Central

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Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis

Elsevier Ltd ;2010 Elsevier Ltd ;2015 INIST-CNRS ;Copyright 2010 Elsevier Ltd. All rights reserved. ;Copyright Elsevier Limited Jun 12-Jun 18, 2010 ;ISSN: 0140-6736 ;ISSN: 1474-547X ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(10)60674-5 ;PMID: 20483451 ;CODEN: LANCAO

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