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7. Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study

Author

Mark, PB, Carrero, JJ, Matsushita, K, Sang, Y, Ballew, SH, Grams, ME, Coresh, J, Surapaneni, A, Brunskill, NJ, Chalmers, J ; https://orcid.org/0000-0002-9931-0580, Chan, L, Chang, AR, Chinnadurai, R, Chodick, G, Cirillo, M, De Zeeuw, D, Evans, M, Garg, AX, Gutierrez, OM, Heerspink, HJL, Heine, GH, Herrington, WG, Ishigami, J, Kronenberg, F, Lee, JY, Levin, A, Major, RW, Marks, A, Nadkarni, GN, Naimark, DMJ, Nowak, C, Rahman, M, Sabanayagam, C, Sarnak, M, Sawhney, S, Schneider, MP, Shalev, V, Shin, JI, Siddiqui, MK, Stempniewicz, N, Sumida, K, Valdivielso, JM, Van Den Brand, J, Yee-Moon Wang, A, Wheeler, DC, Zhang, L, Visseren, FLJ, Stengel, B, Mark, PB, Carrero, JJ, Matsushita, K, Sang, Y, Ballew, SH, Grams, ME, Coresh, J, Surapaneni, A, Brunskill, NJ, Chalmers, J ; https://orcid.org/0000-0002-9931-0580, Chan, L, Chang, AR, Chinnadurai, R, Chodick, G, Cirillo, M, De Zeeuw, D, Evans, M, Garg, AX, Gutierrez, OM, Heerspink, HJL, Heine, GH, Herrington, WG, Ishigami, J, Kronenberg, F, Lee, JY, Levin, A, Major, RW, Marks, A, Nadkarni, GN, Naimark, DMJ, Nowak, C, Rahman, M, Sabanayagam, C, Sarnak, M, Sawhney, S, Schneider, MP, Shalev, V, Shin, JI, Siddiqui, MK, Stempniewicz, N, Sumida, K, Valdivielso, JM, Van Den Brand, J, Yee-Moon Wang, A, Wheeler, DC, Zhang, L, Visseren, FLJ, and Stengel, B

Abstract

Aims: Chronic kidney disease (CKD) increases risk of cardiovascular disease (CVD). Less is known about how CVD associates with future risk of kidney failure with replacement therapy (KFRT). Methods and results: The study included 25 903 761 individuals from the CKD Prognosis Consortium with known baseline estimated glomerular filtration rate (eGFR) and evaluated the impact of prevalent and incident coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF) events as time-varying exposures on KFRT outcomes. Mean age was 53 (standard deviation 17) years and mean eGFR was 89 mL/min/1.73 m2, 15% had diabetes and 8.4% had urinary albumin-to-creatinine ratio (ACR) available (median 13 mg/g); 9.5% had prevalent CHD, 3.2% prior stroke, 3.3% HF, and 4.4% prior AF. During follow-up, there were 269 142 CHD, 311 021 stroke, 712 556 HF, and 605 596 AF incident events and 101 044 (0.4%) patients experienced KFRT. Both prevalent and incident CVD were associated with subsequent KFRT with adjusted hazard ratios (HRs) of 3.1 [95% confidence interval (CI): 2.9-3.3], 2.0 (1.9-2.1), 4.5 (4.2-4.9), 2.8 (2.7-3.1) after incident CHD, stroke, HF and AF, respectively. HRs were highest in first 3 months post-CVD incidence declining to baseline after 3 years. Incident HF hospitalizations showed the strongest association with KFRT [HR 46 (95% CI: 43-50) within 3 months] after adjustment for other CVD subtype incidence. Conclusion: Incident CVD events strongly and independently associate with future KFRT risk, most notably after HF, then CHD, stroke, and AF. Optimal strategies for addressing the dramatic risk of KFRT following CVD events are needed.

Published
2023

8. The Kidney Failure Risk Equation: Evaluation of Novel Input Variables including eGFR Estimated Using the CKD-EPI 2021 Equation in 59 Cohorts

Author

Grams, M.E., Brunskill, N.J., Ballew, Shoshana H., Sang, Y., Coresh, J., Matsushita, K., Surapaneni, A., Bell, S., Carrero, J.J., Chodick, G., Evans, M., Heerspink, H.J., Inker, L.A., Iseki, K., Kalra, P.A., Kirchner, H.L., Lee, B.J., Levin, A., Major, R.W., Medcalf, J., Nadkarni, G.N., Naimark, D.M.J., Ricardo, A.C., Sawhney, S., Sood, M.M., Staplin, N., Stempniewicz, N., Stengel, B., Sumida, K., Traynor, J.P., Brand, J. van den, Wen, C.P., Woodward, M., Yang, J.W., Wang, A.Y., Tangri, N., Grams, M.E., Brunskill, N.J., Ballew, Shoshana H., Sang, Y., Coresh, J., Matsushita, K., Surapaneni, A., Bell, S., Carrero, J.J., Chodick, G., Evans, M., Heerspink, H.J., Inker, L.A., Iseki, K., Kalra, P.A., Kirchner, H.L., Lee, B.J., Levin, A., Major, R.W., Medcalf, J., Nadkarni, G.N., Naimark, D.M.J., Ricardo, A.C., Sawhney, S., Sood, M.M., Staplin, N., Stempniewicz, N., Stengel, B., Sumida, K., Traynor, J.P., Brand, J. van den, Wen, C.P., Woodward, M., Yang, J.W., Wang, A.Y., and Tangri, N.

Abstract

Item does not contain fulltext, SIGNIFICANCE STATEMENT: The kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict 2- and 5-year risk of kidney failure in populations with eGFR <60 ml/min per 1.73 m 2 . However, the CKD-EPI 2021 creatinine equation for eGFR is now recommended for use but has not been fully tested in the context of KFRE. In 59 cohorts comprising 312,424 patients with CKD, the authors assessed the predictive performance and calibration associated with the use of the CKD-EPI 2021 equation and whether additional variables and accounting for the competing risk of death improves the KFRE's performance. The KFRE generally performed well using the CKD-EPI 2021 eGFR in populations with eGFR <45 ml/min per 1.73 m 2 and was not improved by adding the 2-year prior eGFR slope and cardiovascular comorbidities. BACKGROUND: The kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict kidney failure risk in people with GFR <60 ml/min per 1.73 m 2 . METHODS: Using 59 cohorts with 312,424 patients with CKD, we tested several modifications to the KFRE for their potential to improve the KFRE: using the CKD-EPI 2021 creatinine equation for eGFR, substituting 1-year average ACR for single-measure ACR and 1-year average eGFR in participants with high eGFR variability, and adding 2-year prior eGFR slope and cardiovascular comorbidities. We also assessed calibration of the KFRE in subgroups of eGFR and age before and after accounting for the competing risk of death. RESULTS: The KFRE remained accurate and well calibrated overall using the CKD-EPI 2021 eGFR equation. The other modifications did not improve KFRE performance. In subgroups of eGFR 45-59 ml/min per 1.73 m 2 and in older adults using the 5-year time horizon, the KFRE demonstrated systematic underprediction and overprediction, respectively. We developed and tested a new model with a spline term in eGFR and incorporating the competing risk

Published
2023

9. Major cardiovascular events and subsequent risk of kidney failure with replacement therapy: a CKD Prognosis Consortium study

Author

Mark, P.B., Carrero, J.J., Matsushita, K., Sang, Y., Ballew, S.H., Grams, M.E., Coresh, J., Surapaneni, A., Brunskill, N.J., Chalmers, J., Chan, L., Chang, A.R., Chinnadurai, R., Chodick, G., Cirillo, M., Zeeuw, D. de, Evans, M., Garg, A.X., Gutierrez, O.M., Heerspink, H.J.L., Heine, G.H., Herrington, W.G., Ishigami, J., Kronenberg, F., Lee, J.Y., Levin, A., Major, R.W., Marks, A., Nadkarni, G.N., Naimark, D.M.J., Nowak, C., Rahman, M., Sabanayagam, C., Sarnak, M., Sawhney, S., Schneider, M.P., Shalev, V., Shin, J.I., Siddiqui, M.K., Stempniewicz, N., Sumida, K., Valdivielso, J.M., Brand, J. van den, Yee-Moon Wang, A, Wheeler, D.C., Zhang, L., Visseren, F.L.J., Stengel, B., Mark, P.B., Carrero, J.J., Matsushita, K., Sang, Y., Ballew, S.H., Grams, M.E., Coresh, J., Surapaneni, A., Brunskill, N.J., Chalmers, J., Chan, L., Chang, A.R., Chinnadurai, R., Chodick, G., Cirillo, M., Zeeuw, D. de, Evans, M., Garg, A.X., Gutierrez, O.M., Heerspink, H.J.L., Heine, G.H., Herrington, W.G., Ishigami, J., Kronenberg, F., Lee, J.Y., Levin, A., Major, R.W., Marks, A., Nadkarni, G.N., Naimark, D.M.J., Nowak, C., Rahman, M., Sabanayagam, C., Sarnak, M., Sawhney, S., Schneider, M.P., Shalev, V., Shin, J.I., Siddiqui, M.K., Stempniewicz, N., Sumida, K., Valdivielso, J.M., Brand, J. van den, Yee-Moon Wang, A, Wheeler, D.C., Zhang, L., Visseren, F.L.J., and Stengel, B.

Abstract

Item does not contain fulltext, AIMS: Chronic kidney disease (CKD) increases risk of cardiovascular disease (CVD). Less is known about how CVD associates with future risk of kidney failure with replacement therapy (KFRT). METHODS AND RESULTS: The study included 25 903 761 individuals from the CKD Prognosis Consortium with known baseline estimated glomerular filtration rate (eGFR) and evaluated the impact of prevalent and incident coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF) events as time-varying exposures on KFRT outcomes. Mean age was 53 (standard deviation 17) years and mean eGFR was 89 mL/min/1.73 m2, 15% had diabetes and 8.4% had urinary albumin-to-creatinine ratio (ACR) available (median 13 mg/g); 9.5% had prevalent CHD, 3.2% prior stroke, 3.3% HF, and 4.4% prior AF. During follow-up, there were 269 142 CHD, 311 021 stroke, 712 556 HF, and 605 596 AF incident events and 101 044 (0.4%) patients experienced KFRT. Both prevalent and incident CVD were associated with subsequent KFRT with adjusted hazard ratios (HRs) of 3.1 [95% confidence interval (CI): 2.9-3.3], 2.0 (1.9-2.1), 4.5 (4.2-4.9), 2.8 (2.7-3.1) after incident CHD, stroke, HF and AF, respectively. HRs were highest in first 3 months post-CVD incidence declining to baseline after 3 years. Incident HF hospitalizations showed the strongest association with KFRT [HR 46 (95% CI: 43-50) within 3 months] after adjustment for other CVD subtype incidence. CONCLUSION: Incident CVD events strongly and independently associate with future KFRT risk, most notably after HF, then CHD, stroke, and AF. Optimal strategies for addressing the dramatic risk of KFRT following CVD events are needed.

Published
2023

10. Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis

Author

Grams, M.E., Coresh, J., Matsushita, K., Ballew, S.H., Sang, Y., Surapaneni, A., Pinho, N. Alencar de, Anderson, A., Appel, L.J., Ärnlöv, J., Azizi, F., Bansal, N., Bell, S., Bilo, H.J.G., Brunskill, N.J., Carrero, J.J., Chadban, S., Chalmers, J., Chen, J., Ciemins, E., Cirillo, M., Ebert, N., Evans, M., Ferreiro, Alejandro, Fu, E.L., Fukagawa, M., Green, J.A., Gutierrez, O.M., Herrington, W.G., Hwang, S.J., Inker, L.A., Iseki, K., Jafar, T., Jassal, S.K., Jha, V., Kadota, A., Katz, R., Köttgen, A., Konta, T., Kronenberg, F., Lee, B.J., Lees, J., Levin, A., Looker, H.C., Major, R., Cohen, C. Melzer, Mieno, M., Miyazaki, M., Moranne, O., Muraki, I., Naimark, D., Nitsch, D., Oh, W., Pena, M., Purnell, T.S., Sabanayagam, C., Satoh, M., Sawhney, S., Schaeffner, E., Schöttker, B., Shen, J.I., Shlipak, M.G., Sinha, S., Stengel, B., Sumida, K., Tonelli, M., Valdivielso, J.M., Zuilen, A.D. van, Visseren, F.L.J., Wang, A.Y., Wen, C.P., Wheeler, D.C., Yatsuya, H., Yamagata, K., Yang, J.W., Young, A., Zhang, Haitao, Zhang, L., Wetzels, J.F.M., Levey, A.S., Gansevoort, R.T., Grams, M.E., Coresh, J., Matsushita, K., Ballew, S.H., Sang, Y., Surapaneni, A., Pinho, N. Alencar de, Anderson, A., Appel, L.J., Ärnlöv, J., Azizi, F., Bansal, N., Bell, S., Bilo, H.J.G., Brunskill, N.J., Carrero, J.J., Chadban, S., Chalmers, J., Chen, J., Ciemins, E., Cirillo, M., Ebert, N., Evans, M., Ferreiro, Alejandro, Fu, E.L., Fukagawa, M., Green, J.A., Gutierrez, O.M., Herrington, W.G., Hwang, S.J., Inker, L.A., Iseki, K., Jafar, T., Jassal, S.K., Jha, V., Kadota, A., Katz, R., Köttgen, A., Konta, T., Kronenberg, F., Lee, B.J., Lees, J., Levin, A., Looker, H.C., Major, R., Cohen, C. Melzer, Mieno, M., Miyazaki, M., Moranne, O., Muraki, I., Naimark, D., Nitsch, D., Oh, W., Pena, M., Purnell, T.S., Sabanayagam, C., Satoh, M., Sawhney, S., Schaeffner, E., Schöttker, B., Shen, J.I., Shlipak, M.G., Sinha, S., Stengel, B., Sumida, K., Tonelli, M., Valdivielso, J.M., Zuilen, A.D. van, Visseren, F.L.J., Wang, A.Y., Wen, C.P., Wheeler, D.C., Yatsuya, H., Yamagata, K., Yang, J.W., Young, A., Zhang, Haitao, Zhang, L., Wetzels, J.F.M., Levey, A.S., and Gansevoort, R.T.

Abstract

Item does not contain fulltext, IMPORTANCE: Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. OBJECTIVE: To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. EXPOSURES: The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). MAIN OUTCOMES AND MEASURES: The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. RESULTS: Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associ

Published
2023

29. POS-234 PRAGMATIC DESIGN FOR A GLOBAL COLLABORATIVE STUDY ON HEMOGLOBIN VARIABILITY WITHIN THE ISN INTERNATIONAL NETWORK OF CKD COHORTS (INET-CKD)

Author

CANNEY, M., primary, Tang, M., additional, Induruwage, D., additional, Er, L., additional, Zheng, S., additional, Zhao, Y., additional, Alencar De Pinho, N., additional, Stengel, B., additional, Taal, M., additional, Dionne, J., additional, Feldman, H., additional, Hiemstra, T., additional, Sackeyfio, A., additional, Djurdjev, O., additional, and Levin, A., additional

Published
2022
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30. Urinary creatinine excretion, measured glomerular filtration rate and CKD outcomes

Author

Tynkevich, Elena, Flamant, Martin, Haymann, Jean-Philippe, Metzger, Marie, Thervet, Eric, Boffa, Jean-Jacques, Vrtovsnik, François, Houillier, Pascal, Froissart, Marc, Stengel, Bénédicte, Flamant, M., Haymann, J.P., Houillier, P., Thervet, E., Boffa, J.J., Vrtovsnik, F., Stengel, B., Metzger, M., Letavernier, E., Urena, P., Courbebaisse, M., Maruani, G., Vallet, M., Rougier, J.P.H., Rondeau, E., Ronco, P., Plaisier, E., Fessi, H., Descamps, C., de La Faille, R., Dautheville, S., Daugas, E., d Auzac, C., Costa, M. A., and Bouet, J.

Published
2015
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39. A multivariable model for improved prediction of kidney failure requiring kidney replacement therapy based on routine laboratory parameters

Author

Zacharias, H, Altenbuchinger, M, Schultheiß, U, Raffler, J, Kotsis, F, Ghasemi, S, Ali, I, Metzger, M, Steinbrenner, I, Sekula, P, Massy, Z, Combe, C, Kalra, P, Kronenberg, F, Stengel, B, Eckardt, KU, Köttgen, A, Schmid, M, Gronwald, W, Oefner, P, Zacharias, H, Altenbuchinger, M, Schultheiß, U, Raffler, J, Kotsis, F, Ghasemi, S, Ali, I, Metzger, M, Steinbrenner, I, Sekula, P, Massy, Z, Combe, C, Kalra, P, Kronenberg, F, Stengel, B, Eckardt, KU, Köttgen, A, Schmid, M, Gronwald, W, and Oefner, P

Published
2021

46. Adiposity and risk of decline in glomerular filtration rate : Meta-analysis of individual participant data in a global consortium

Author

Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M, Gutierrez OM, Hosseinpanah F, Iseki K, Kenealy T, Klein B, Kronenberg F, Lee BJ, Li Y, Miura K, Navaneethan SD, Roderick PJ, Valdivielso JM, Visseren FLJ, Zhang L, Gansevoort RT, Hallan SI, Levey AS, Matsushita K, Shalev V, Woodward M, Astor B, Appel L, Greene T, Chen T, Chalmers J, Arima H, Perkovic V, Yatsuya H, Tamakoshi K, Hirakawa Y, Coresh J, Sang Y, Polkinghorne K, Chadban S, Atkins R, Levin A, Djurdjev O, Klein R, Lee K, Liu L, Zhao M, Wang F, Wang J, Tang M, Heine G, Emrich I, Zawada A, Bauer L, Nally J, Schold J, Shlipak M, Sarnak M, Katz R, Hiramoto J, Iso H, Yamagishi K, Umesawa M, Muraki I, Fukagawa M, Maruyama S, Hamano T, Hasegawa T, Fujii N, Jafar T, Hatcher J, Poulter N, Chaturvedi N, Wheeler D, Emberson J, Townend J, Landray M, Brenner H, Schöttker B, Saum KU, Rothenbacher D, Fox C, Hwang SJ, Köttgen A, Schneider MP, Eckardt KU, Green J, Kirchner HL, Ito S, Miyazaki M, Nakayama M, Yamada G, Cirillo M, Romundstad S, Øvrehus M, Langlo KA, Irie F, Sairenchi T, Rebholz CM, Young B, Boulware LE, Ishikawa S, Yano Y, Kotani K, Nakamura T, Jee SH, Kimm H, Mok Y, Chodick G, Wetzels JFM, Blankestijn PJ, van Zuilen AD, Bots M, Inker L, Peralta C, Kollerits B, Ritz E, Nitsch D, Fletcher A, Bottinger E, Nadkarni GN, Ellis SB, Nadukuru R, Fernandez E, Betriu A, Bermudez-Lopez M, Stengel B, Metzger M, Flamant M, Houillier P, Haymann JP, Froissart M, Ueshima H, Okayama A, Tanaka S, Okamura T, Elley CR, Collins JF, Drury PL, Ohkubo T, Asayama K, Metoki H, Kikuya M, Iseki C, Nelson RG, Knowler WC, Bakker SJL, Heerspink HJL, Brunskill N, Major R, Shepherd D, Medcalf J, Jassal SK, Bergstrom J, Ix JH, Barrett-Connor E, Kovesdy C, Kalantar-Zadeh K, Sumida K, Muntner P, Warnock D, Judd S, Panwar B, de Zeeuw D, Brenner B, Sedaghat S, Ikram MA, Hoorn EJ, Dehghan A, Wong TY, Sabanayagam C, Cheng CY, Banu R, Segelmark M, Stendahl M, Schön S, Tangri N, Sud M, Naimark D, Wen CP, Tsao CK, Tsai MK, Chen CH, Konta T, Hirayama A, Ichikawa K, Hadaegh F, Mirbolouk M, Azizi F, Solbu MD, Jenssen TG, Eriksen BO, Eggen AE, Lannfelt L, Larsson A, Ärnlöv J, Landman GWD, van Hateren KJJ, Kleefstra N, Chen J, Kwak L, Surapaneni A., Chang, Ar, Grams, Me, Ballew, Sh, Bilo, H, Correa, A, Evans, M, Gutierrez, Om, Hosseinpanah F, Iseki K, Kenealy, T, Klein, B, Kronenberg, F, Lee, Bj, Li, Y, Miura, K, Navaneethan, Sd, Roderick, Pj, Valdivielso, Jm, Visseren, Flj, Zhang, L, Gansevoort, Rt, Hallan, Si, Levey, A, Matsushita, K, Shalev, V, Woodward, M, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Arima, H, Perkovic, V, Yatsuya, H, Tamakoshi, K, Hirakawa, Y, Coresh, J, Sang, Y, Polkinghorne, K, Chadban, S, Atkins, R, Levin, A, Djurdjev, O, Klein, R, Lee, K, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Heine, G, Emrich, I, Zawada, A, Bauer, L, Nally, J, Schold, J, Shlipak, M, Sarnak, M, Katz, R, Hiramoto, J, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Hasegawa, T, Fujii, N, Jafar, T, Hatcher, J, Poulter, N, Chaturvedi, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Brenner, H, Schöttker, B, Saum, Ku, Rothenbacher, D, Fox, C, Hwang, Sj, Köttgen, A, Schneider, Mp, Eckardt, Ku, Green, J, Kirchner, Hl, Ito, S, Miyazaki, M, Nakayama, M, Yamada, G, Cirillo, M, Romundstad, S, Øvrehus, M, Langlo, Ka, Irie, F, Sairenchi, T, Rebholz, Cm, Young, B, Boulware, Le, Ishikawa, S, Yano, Y, Kotani, K, Nakamura, T, Jee, Sh, Kimm, H, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, van Zuilen, Ad, Bots, M, Inker, L, Peralta, C, Kollerits, B, Ritz, E, Nitsch, D, Fletcher, A, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Fernandez, E, Betriu, A, Bermudez-Lopez, M, Stengel, B, Metzger, M, Flamant, M, Houillier, P, Haymann, Jp, Froissart, M, Ueshima, H, Okayama, A, Tanaka, S, Okamura, T, Elley, Cr, Collins, Jf, Drury, Pl, Ohkubo, T, Asayama, K, Metoki, H, Kikuya, M, Iseki, C, Nelson, Rg, Knowler, Wc, Bakker, Sjl, Heerspink, Hjl, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, Sumida, K, Muntner, P, Warnock, D, Judd, S, Panwar, B, de Zeeuw, D, Brenner, B, Sedaghat, S, Ikram, Ma, Hoorn, Ej, Dehghan, A, Wong, Ty, Sabanayagam, C, Cheng, Cy, Banu, R, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, Cp, Tsao, Ck, Tsai, Mk, Chen, Ch, Konta, T, Hirayama, A, Ichikawa, K, Hadaegh, F, Mirbolouk, M, Azizi, F, Solbu, Md, Jenssen, Tg, Eriksen, Bo, Eggen, Ae, Lannfelt, L, Larsson, A, Ärnlöv, J, Landman, Gwd, van Hateren, Kjj, Kleefstra, N, Chen, J, Kwak, L, Surapaneni, A., Lifestyle Medicine (LM), Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Asayama, Kei, and Sedaghat, SeyyedMah

Subjects
CHRONIC KIDNEY-DISEASE, Male, 030232 urology & nephrology, 030204 cardiovascular system & hematology, OBESITY PARADOX, Body Mass Index, BMI, eGFR, CKD-PC, Cohort Studies, 0302 clinical medicine, Risk Factors, Urologi och njurmedicin, Medicine, ALL-CAUSE MORTALITY, Adiposity, 2. Zero hunger, Aged, 80 and over, Medicine(all), education.field_of_study, Hazard ratio, ASSOCIATION, General Medicine, Middle Aged, 3. Good health, Cohort, Female, Waist Circumference, Life Sciences & Biomedicine, WAIST CIRCUMFERENCE, Obesity paradox, Glomerular Filtration Rate, Adult, Waist, Population, Renal function, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, CKD, Urology and Nephrology, Humans, Mortality, education, Aged, Science & Technology, business.industry, Research, medicine.disease, Body Height, BODY-MASS INDEX, Kidney Failure, Chronic, WEIGHT, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Body mass index, Demography, Kidney disease
Abstract

ObjectiveTo evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.DesignIndividual participant data meta-analysis.SettingCohorts from 40 countries with data collected between 1970 and 2017.ParticipantsAdults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).Main outcome measuresGFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR 2) and all cause mortality.ResultsOver a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.ConclusionsElevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

Published
2019

47. SUN-095 INTERNATIONAL VARIATION IN CLINIC HEMOGLOBIN TARGETS AND ACHIEVED HEMOGLOBIN LEVELS IN ADVANCED CKD: RESULTS FROM THE CKD OUTCOMES AND PRACTICE PATTERNS STUDY (CKDOPPS)

Author

Lopes, M., primary, Tu, C., additional, Zee, J., additional, Allum, A., additional, van Haalen, H., additional, Sloand, J., additional, Glen, J., additional, Reichel, H., additional, Stengel, B., additional, Sukul, N., additional, Wong, M., additional, Lopes, A.A., additional, Pisoni, R., additional, Robinson, B., additional, and Pecoits-Filho, R., additional

Published
2020
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49. Worldwide Disparity in the Relation Between CKD Prevalence and Kidney Failure Risk

Author

Rijn, M.H.C. van, Pinho, N. Alencar de, Wetzels, J., Brand, J. van den, and Stengel, B.

Subjects
Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

Contains fulltext : 229541.pdf (Publisher’s version ) (Open Access) INTRODUCTION: The incidence of kidney replacement therapy (KRT) for kidney failure varies internationally much more than chronic kidney disease (CKD) prevalence. This ecologic study investigated the relation of CKD prevalence to KRT and mortality risks by world region. METHODS: We used data from Global Burden of Disease and KRT registries worldwide with linear models to estimate the percentages of variance in KRT incidence and all-cause mortality explained by age-adjusted prevalence of CKD stages 3 to 5, overall and by gender, in 61 countries classified in 3 regions: high income (n = 28), Eastern and Central Europe (n = 15), and other (n = 18). RESULTS: The incidence of KRT ranged from 89 to 378 per million population in high-income regions, 32 to 222 per million population in Central and Eastern Europe, and 22 to 493 per million population in the other region; age-adjusted CKD prevalence ranged from 5.5% to 10.4%, 7.6% to 13.7%, and 7.4% to 13.1%, respectively. The relation between these indicators was positive in high-income countries, negative in Central and Eastern Europe, and null in the other region. Age-adjusted CKD prevalence explained 40% of the variance in KRT incidence (P < 0.001) in high-income countries. The explained variance of age-adjusted mortality was close to 0 in high-income countries and positive at 19% (P = 0.10) in Central and Eastern Europe and at 11% (P = 0.17) in the other region. Results were consistent by gender. CONCLUSION: This study raises awareness on the significant part of the gaps in KRT incidence across countries not explained by the number of individuals with CKD, even in high-income countries where access to KRT is not limited.

Published
2020

50. Longitudinal Serum Bicarbonate Measurements and Risk of Chronic Kidney Disease Progression and Mortality: Insights from the Ckd-Rein Cohort

Author

Prezelin-Reydit, Mathilde, Combe, C., HARAMBAT, Jerome, Massy, Z., Metzger, M., Lange, C., Lambert, O., Stengel, B., Leffondre, Karen, Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Biostatistics, urologic and male genital diseases, female genital diseases and pregnancy complications, LEHA
Abstract

Background and AimsMetabolic acidosis is a common complication of CKD and may contribute to CKD progression. However, the association between serum bicarbonate and CKD progression has not yet been investigated using longitudinal measurements.MethodWe used data from CKD-REIN, a prospective cohort study conducted in 40 representative French nephrology clinics which included 3033 patients with CKD stages 3 to 5 between 2013 and 2016. Patients who had no serum bicarbonate or no creatinine measure at within 6 months of their inclusion date in the CKD-REIN study were excluded. All serum bicarbonate measurements were taken into account, from inclusion to the occurrence of renal replacement therapy (RRT), death, or end of follow-up, whichever came first. We used a shared random-effect model for the joint analysis of individual trajectories of serum bicarbonate and the hazard of the composite outcome (RRT or death before RRT) and each specific event separately. Hazard ratio were adjusted (aHR) for age, sex, primary kidney disease, metabolic syndrome, cardiovascular disease, proteinuria (< 30, 30-300, > 300 mg/day), and the CKD-EPI estimated glomerular filtration rate (eGFR) at baseline.ResultsA total of 2977 patients (65.4% men, median age 69 years) were included. At baseline, the median eGFR was 31.8 mL/min/1.73m2 and the median bicarbonate concentration was 25 mmol/L. During a median follow-up of 4.5 years, 615 patients received RRT and 378 died before RRT. At any time of follow-up, a decrease of 1 mmol/l of the current level of serum bicarbonate was associated with a significantly increased hazard of RRT or death before RRT (aHR 1.05, 95%CI 1.02-1.08). The estimated effect was stronger on death before RRT (aHR 1.05, 95% CI 1.00-1.09) than on RRT (aHR 1.02, 95% CI 0.99-1.06).ConclusionA lower current level of serum bicarbonate is associated with an increased mortality in patients with CKD stage 3 to 5.

Published
2020
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