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1. Relative risks of Chronic Kidney Disease for mortality and End Stage Renal Disease across races is similar

Author

Wright, Jt, Appel, L, Greene, T, Astor, Bc, Chalmers, J, Macmahon, S, Woodward, M, Arima, H, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Coresh, J, Matsushita, K, Atkins, Rc, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Liu, L, Levin, A, Djurdjev, O, Tonelli, M, Sacks, F, Curhan, G, Shlipak, M, Peralta, C, Katz, R, Fried, L, Iso, H, Kitamura, A, Ohira, T, Yamagishi, K, Jafar, Th, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Emberson, J, Townend, J, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Fox, Cs, Hwang, Sj, Meigs, Jb, Perkins, Rm, Fluck, N, Clark, L, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasard, K, Øien, Cm, Radtke, M, Irie, F, Sairenchi, T, Smith, Dh, Weiss, J, Johnson, Es, Thorp, Ml, Collins, Aj, Vassalotti, Ja, Li, S, Chen, Sc, Lee, Bj, Wetzels, Jf, Blankestijn, Pj, Van, Zuilen, Sarnak, M, Levey, As, Inker, L, Menon, V, Fried, Lf, Kramer, H, Boer, De, I, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, J, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, Gansevoort, Rt, Jong, De, Mahmoodi, Bk, Bakker, Sj, Bernardo, R, Kaur, Jassal, S, Barrett Connor, E, Bergstrom, J, Heerspink, Hj, Brenner, B, Zeeuw, De, D, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, W, Jee, Sh, Kimm, H, Jo, J, Mok, Y, Choi, E, Rossing, P, Parving, Hh, Tangri, N, Naimark, D, Wen, Cp, Wen, Sf, Tsao, Ck, Tsai, Mk, Wu, Be, Ärnlöv, J, Lannfelt, L, Larsson, A, Bilo, Hj, Joosten, H, Kleefstra, N, Groenier, Kh, Drion, I, Hemmelgarn, Br, Ballew, Sh, Grams, M, Sang, Y, Camarata, L, Hui, X, Seltzer, J, Winegrad, H., Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Wright, Jt, Jr, Appel, L, Greene, T, Astor, Bc, Chalmers, J, Macmahon, S, Woodward, M, Arima, H, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Coresh, J, Matsushita, K, Atkins, Rc, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Liu, L, Levin, A, Djurdjev, O, Tonelli, M, Sacks, F, Curhan, G, Shlipak, M, Peralta, C, Katz, R, Fried, L, Iso, H, Kitamura, A, Ohira, T, Yamagishi, K, Jafar, Th, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Emberson, J, Townend, J, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Fox, C, Hwang, Sj, Meigs, Jb, Perkins, Rm, Fluck, N, Clark, L, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasard, K, Øien, Cm, Radtke, M, Irie, F, Sairenchi, T, Smith, Dh, Weiss, J, Johnson, E, Thorp, Ml, Collins, Aj, Vassalotti, Ja, Li, S, Chen, Sc, Lee, Bj, Wetzels, Jf, Blankestijn, Pj, Van, Zuilen, Ad, Sarnak, M, Levey, A, Inker, L, Menon, V, Fried, Lf, Kramer, H, De, Boer, I, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, J, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, Gansevoort, Rt, De, Jong, Pe, Mahmoodi, Bk, Bakker, Sj, Bernardo, R, Kaur, Jassal, S, Barrett Connor, E, Bergstrom, J, Heerspink, Hj, Brenner, B, De, Zeeuw, D, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, W, Jee, Sh, Kimm, H, Jo, J, Mok, Y, Choi, E, Rossing, P, Parving, Hh, Tangri, N, Naimark, D, Wen, Cp, Wen, Sf, Tsao, Ck, Tsai, Mk, Be, Wu, Ärnlöv, J, Lannfelt, L, Larsson, A, Bilo, Hj, Joosten, H, Kleefstra, N, Groenier, Kh, Drion, I, Hemmelgarn, Br, Ballew, Sh, Grams, M, Sang, Y, Camarata, L, Hui, X, Seltzer, J, and Winegrad, H.

Subjects
Male, GLOMERULAR-FILTRATION-RATE, Cohort Studies, Risk Factors, eGFR, Odds Ratio, ASSOCIATIONS, African Continental Ancestry Group, Aged, 80 and over, education.field_of_study, end-stage renal disease, Hazard ratio, PROTEINURIA, Urology & Nephrology, Middle Aged, CKD-EPI EQUATION, 3. Good health, PREVALENCE, Nephrology, Cardiovascular Diseases, Creatinine, ethnicity, Female, medicine.symptom, epidemiology and outcomes, Glomerular Filtration Rate, Asian Continental Ancestry Group, Adult, medicine.medical_specialty, Population, European Continental Ancestry Group, Renal function, Black People, ALL-CAUSE, Article, White People, End stage renal disease, Asian People, Internal medicine, medicine, Chronic Kidney Disease Prognosis Consortium, Albuminuria, Humans, Renal Insufficiency, Chronic, education, Aged, business.industry, 1103 Clinical Sciences, Odds ratio, POPULATION COHORTS, medicine.disease, INDIVIDUALS, Endocrinology, Relative risk, COLLABORATIVE METAANALYSIS, mortality risk, Kidney Failure, Chronic, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, HIGHER ALBUMINURIA, chronic kidney disease, Kidney disease
Abstract

Item does not contain fulltext Some suggest race-specific cutpoints for kidney measures to define and stage chronic kidney disease (CKD), but evidence for race-specific clinical impact is limited. To address this issue, we compared hazard ratios of estimated glomerular filtration rates (eGFR) and albuminuria across races using meta-regression in 1.1 million adults (75% Asians, 21% Whites, and 4% Blacks) from 45 cohorts. Results came mainly from 25 general population cohorts comprising 0.9 million individuals. The associations of lower eGFR and higher albuminuria with mortality and end-stage renal disease (ESRD) were largely similar across races. For example, in Asians, Whites, and Blacks, the adjusted hazard ratios (95% confidence interval) for eGFR 45-59 versus 90-104 ml/min per 1.73 m(2) were 1.3 (1.2-1.3), 1.1 (1.0-1.2), and 1.3 (1.1-1.7) for all-cause mortality, 1.6 (1.5-1.7), 1.4 (1.2-1.7), and 1.4 (0.7-2.9) for cardiovascular mortality, and 27.6 (11.1-68.7), 11.2 (6.0-20.9), and 4.1 (2.2-7.5) for ESRD, respectively. The corresponding hazard ratios for urine albumin-to-creatinine ratio 30-299 mg/g or dipstick 1+ versus an albumin-to-creatinine ratio under 10 or dipstick negative were 1.6 (1.4-1.8), 1.7 (1.5-1.9), and 1.8 (1.7-2.1) for all-cause mortality, 1.7 (1.4-2.0), 1.8 (1.5-2.1), and 2.8 (2.2-3.6) for cardiovascular mortality, and 7.4 (2.0-27.6), 4.0 (2.8-5.9), and 5.6 (3.4-9.2) for ESRD, respectively. Thus, the relative mortality or ESRD risks of lower eGFR and higher albuminuria were largely similar among three major races, supporting similar clinical approach to CKD definition and staging, across races.

Published
2014

2. Age and Association of Kidney Measures With Mortality and End-stage Renal Disease

Author

Wright, Jt, Appel, Lj, Greene, T, Astor, Bc, Chalmers, J, Macmahon, S, Woodward, M, Arima, H, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Tonelli, M, Hemmelgarn, Br, Bello, A, James, Mt, Coresh, J, Matsushita, K, Sang, Y, Atkins, Rc, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Levin, A, Djurdjev, O, Sacks, Fm, Curhan, Gc, Shlipak, M, Peralta, C, Katz, R, Fried, Lf, Iso, H, Kitamura, A, Ohira, T, Yamagishi, K, Jafar, Th, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Emberson, J, Townend, Jn, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Fox, Cs, Hwang, Sj, Meigs, Jb, Perkins, Rm, Fluck, N, Clark, Le, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasarød, K, Øien, Cm, Radtke, M, Irie, F, Sairenchi, T, Smith, Dh, Weiss, Jw, Johnson, Es, Thorp, Ml, Collins, Aj, Vassalotti, Ja, Li, S, Chen, Sc, Lee, Bj, Wetzels, Jf, Blankestijn, Pj, Van, Zuilen, Sarnak, M, Levey, As, Inker, La, Menon, V, Kramer, Hj, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, Jd, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, Gansevoort, Rt, Jong, De, Mahmoodi, Bk, Heerspink, Hj, Jassal, Sk, Barrett Connor, E, Bergstrom, J, Brenner, Be, Zeeuw, De, D, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, W, Jee, Sh, Kimm, H, Jo, J, Mok, Y, Lim, Je, Rossing, P, Parving, Hh, Tangri, N, Naimark, D, Wen, Cp, Wen, Sf, Tsao, Ck, Tsai, Mk, Ärnlöv, J, Lannfelt, L, Larsson, A, Bilo, Hj, Joosten, H, Kleefstra, N, Groenier, Kh, Drion, I, Ballew, Sh, Grams, M, Camarata, L, Hui, X, Seltzer, J, Winegrad, H., Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Wright JT Jr, Appel, Lj, Greene, T, Astor, Bc, Chalmers, J, Macmahon, S, Woodward, M, Arima, H, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Tonelli, M, Hemmelgarn, Br, Bello, A, James, Mt, Coresh, J, Matsushita, K, Sang, Y, Atkins, Rc, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Levin, A, Djurdjev, O, Sacks, Fm, Curhan, Gc, Shlipak, M, Peralta, C, Katz, R, Fried, Lf, Iso, H, Kitamura, A, Ohira, T, Yamagishi, K, Jafar, Th, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Emberson, J, Townend, Jn, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Fox, C, Hwang, Sj, Meigs, Jb, Perkins, Rm, Fluck, N, Clark, Le, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasarød, K, Øien, Cm, Radtke, M, Irie, F, Sairenchi, T, Smith, Dh, Weiss, Jw, Johnson, E, Thorp, Ml, Collins, Aj, Vassalotti, Ja, Li, S, Chen, Sc, Lee, Bj, Wetzels, Jf, Blankestijn, Pj, van Zuilen AD, Sarnak, M, Levey, A, Inker, La, Menon, V, Kramer, Hj, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, Jd, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, Gansevoort, Rt, de Jong PE, Mahmoodi, Bk, Heerspink, Hj, Jassal, Sk, Barrett-Connor, E, Bergstrom, J, Brenner, Be, de Zeeuw, D, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, W, Jee, Sh, Kimm, H, Jo, J, Mok, Y, Lim, Je, Rossing, P, Parving, Hh, Tangri, N, Naimark, D, Wen, Cp, Wen, Sf, Tsao, Ck, Tsai, Mk, Ärnlöv, J, Lannfelt, L, Larsson, A, Bilo, Hj, Joosten, H, Kleefstra, N, Groenier, Kh, Drion, I, Ballew, Sh, Grams, M, Camarata, L, Hui, X, Seltzer, J, and Winegrad, H.

Subjects
Male, BLOOD-PRESSURE, urologic and male genital diseases, Kidney, età, GLOMERULAR-FILTRATION-RATE, Cohort Studies, eGFR, Young adult, Renal disorder [IGMD 9], ALL-CAUSE MORTALITY, GENERAL-POPULATION, insufficienza renale, biology, CYSTATIN C, CARDIOVASCULAR RISK, Age Factors, General Medicine, Middle Aged, female genital diseases and pregnancy complications, RISK POPULATION COHORTS, medicine.anatomical_structure, Female, medicine.symptom, Glomerular Filtration Rate, albuminuria, rischio, mortalità, Adult, Risk, medicine.medical_specialty, Adolescent, Renal function, Context (language use), End stage renal disease, Young Adult, Internal medicine, medicine, Albuminuria, Humans, OLDER-ADULTS, Aged, urogenital system, business.industry, URINARY ALBUMIN EXCRETION, medicine.disease, Endocrinology, Cystatin C, COLLABORATIVE METAANALYSIS, biology.protein, Kidney Failure, Chronic, business, Kidney disease
Abstract

Context Chronic kidney disease (CKD) is prevalent in older individuals, but the risk implications of low estimated glomerular filtration rate (eGFR) and high albuminuria across the full age range are controversial.Objective To evaluate possible effect modification (interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks.Design, Setting, and Participants Individual-level meta-analysis including 2 051 244 participants from 33 general population or high-risk (of vascular disease) cohorts and 13 CKD cohorts from Asia, Australasia, Europe, and North/South America, conducted in 1972-2011 with a mean follow-up time of 5.8 years (range, 0-31 years).Main Outcome Measures Hazard ratios (HRs) of mortality and end-stage renal disease (ESRD) according to eGFR and albuminuria were meta-analyzed across age categories after adjusting for sex, race, cardiovascular disease, diabetes, systolic blood pressure, cholesterol, body mass index, and smoking. Absolute risks were estimated using HRs and average incidence rates.Results Mortality (112 325 deaths) and ESRD (8411 events) risks were higher at lower eGFR and higher albuminuria in every age category. In general and high-risk cohorts, relative mortality risk for reduced eGFR decreased with increasing age; eg, adjusted HRs at an eGFR of 45 mL/min/1.73 m(2) vs 80 mL/min/1.73 m(2) were 3.50 (95% CI, 2.55-4.81), 2.21 (95% CI, 2.02-2.41), 1.59 (95% CI, 1.42-1.77), and 1.35 (95% CI, 1.23-1.48) in age categories 18-54, 55-64, 65-74, and >= 75 years, respectively (P Conclusions Both low eGFR and high albuminuria were independently associated with mortality and ESRD regardless of age across a wide range of populations. Mortality showed lower relative risk but higher absolute risk differences at older age.

Published
2012
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3. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis

Author

Fox, Cs, Matsushita, K, Woodward, M, Bilo, Hj, Chalmers, J, Heerspink, Hj, Lee, Bj, Perkins, Rm, Rossing, P, Sairenchi, T, Tonelli, M, Vassalotti, Ja, Yamagishi, K, Coresh, J, Jong, De, Wen, Cp, Nelson, Rg, Chronic, Kidney, Disease, Prognosis, Consortium, Investigators/collaborators:, Wright, J, Appel, L, Greene, T, Astor, Bc, Macmahon, S, Arima, H, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Sang, Y, Atkins, Rc, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Levin, A, Djurdjev, O, Sacks, Fm, Curhan, Gc, Shlipak, M, Peralta, C, Katz, R, Fried, L, Iso, H, Kitamura, A, Ohira, T, Jafar, Th, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Emberson, Jr, Townend, Jn, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Hwang, Sj, Meigs, Jb, Fluck, N, Clark, Le, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasarød, K, Øien, Cm, Radtke, M, Irie, F, Smith, Dh, Weiss, Jw, Johnson, Es, Thorp, Ml, Collins, Aj, Li, S, Chen, Sc, Wetzels, Jf, Blankestijn, Pj, Van, Zuilen, Sarnak, M, Levey, As, Menon, V, Kramer, Hj, Boer, De, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, Jd, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Knowler, Wc, Gansevoort, Rt, Mahmoodi, Bk, Bakker, Sj, Jassal, Sk, Barrett Connor, E, Bergstrom, J, Lambers, Heerspink, Brenner, Be, Zeeuw, D, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, W, Jee, Sh, Kimm, H, Jo, J, Mok, Y, Lim, Je, Parving, Hh, Tangri, N, Naimark, D, Wen, Sf, Tsao, Ck, Tsai, Mk, Ärnlöv, J, Lannfelt, L, Larsson, A, Joosten, H, Kleefstra, N, Groenier, Kh, Drion, I, Hemmelgarn, B, Ballew, Sh, Grams, M, Camarata, L, Hui, X, Seltzer, J, Winegrad, H., Groningen Kidney Center (GKC), Methods in Medicines evaluation & Outcomes research (M2O), Lifestyle Medicine (LM), Fox, C, Matsushita, K, Woodward, M, Bilo, Hj, Chalmers, J, Heerspink, Hj, Lee, Bj, Perkins, Rm, Rossing, P, Sairenchi, T, Tonelli, M, Vassalotti, Ja, Yamagishi, K, Coresh, J, de Jong PE, Wen, Cp, Nelson, Rg, Investigators/Collaborators: Wright J, Chronic Kidney Disease Prognosis Consortium, Appel, L, Greene, T, Astor, Bc, Macmahon, S, Arima, H, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Sang, Y, Atkins, Rc, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Levin, A, Djurdjev, O, Sacks, Fm, Curhan, Gc, Shlipak, M, Peralta, C, Katz, R, Fried, L, Iso, H, Kitamura, A, Ohira, T, Jafar, Th, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Emberson, Jr, Townend, Jn, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Hwang, Sj, Meigs, Jb, Fluck, N, Clark, Le, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasarød, K, Øien, Cm, Radtke, M, Irie, F, Smith, Dh, Weiss, Jw, Johnson, E, Thorp, Ml, Collins, Aj, Li, S, Chen, Sc, Wetzels, Jf, Blankestijn, Pj, van Zuilen AD, Sarnak, M, Levey, A, Menon, V, Kramer, Hj, de Boer IH, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, Jd, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Knowler, Wc, Gansevoort, Rt, Mahmoodi, Bk, Bakker, Sj, Jassal, Sk, Barrett-Connor, E, Bergstrom, J, Lambers Heerspink HJ, Brenner, Be, Zeeuw, D, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, W, Jee, Sh, Kimm, H, Jo, J, Mok, Y, Lim, Je, Parving, Hh, Tangri, N, Naimark, D, Wen, Sf, Tsao, Ck, Tsai, Mk, Ärnlöv, J, Lannfelt, L, Larsson, A, Joosten, H, Kleefstra, N, Groenier, Kh, Drion, I, Hemmelgarn, B, Ballew, Sh, Grams, M, Camarata, L, Hui, X, Seltzer, J, and Winegrad, H.

Subjects
medicine.medical_specialty, Population, UNITED-STATES, Renal function, ALL-CAUSE, GLOMERULAR-FILTRATION-RATE, albuminuria, End stage renal disease, Diabetic nephropathy, CKD-PC Consortium, Diabetes mellitus, Internal medicine, eGFR, Medicine, ESTIMATED GFR, education, Intensive care medicine, Renal disorder [IGMD 9], OUTCOMES, education.field_of_study, end-stage renal disease, diabetes, business.industry, Hazard ratio, PROTEINURIA, General Medicine, mortality, medicine.disease, RISK POPULATION COHORTS, PREVALENCE, diabete, COLLABORATIVE METAANALYSIS, Albuminuria, medicine.symptom, HIGHER ALBUMINURIA, business, Kidney disease
Abstract

Item does not contain fulltext BACKGROUND: Chronic kidney disease is characterised by low estimated glomerular filtration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modified by diabetes is unknown. METHODS: We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and end-stage renal disease (ESRD) associated with eGFR and albuminuria in individuals with and without diabetes. FINDINGS: We analysed data for 1,024,977 participants (128,505 with diabetes) from 30 general population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and high-risk cohorts with data for all-cause mortality, 75,306 deaths occurred during a mean follow-up of 8.5 years (SD 5.0). In the 23 studies with data for cardiovascular mortality, 21,237 deaths occurred from cardiovascular disease during a mean follow-up of 9.2 years (SD 4.9). In the general and high-risk cohorts, mortality risks were 1.2-1.9 times higher for participants with diabetes than for those without diabetes across the ranges of eGFR and albumin-to-creatinine ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes groups, HR of mortality outcomes according to lower eGFR and higher ACR were much the same in participants with and without diabetes (eg, for all-cause mortality at eGFR 45 mL/min per 1.73 m(2) [vs 95 mL/min per 1.73 m(2)], HR 1.35; 95% CI 1.18-1.55; vs 1.33; 1.19-1.48 and at ACR 30 mg/g [vs 5 mg/g], 1.50; 1.35-1.65 vs 1.52; 1.38-1.67). The overall interactions were not significant. We identified much the same findings for ESRD in the chronic kidney disease cohorts. INTERPRETATION: Despite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes. FUNDING: US National Kidney Foundation.

Published
2012
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4. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate

Author

Matsushita, K, Mahmoodi, Bk, Woodward, M, Emberson, Jr, Jafar, Th, Jee, Sh, Polkinghorne, Kr, Shankar, A, Smith, Dh, Tonelli, M, Warnock, Dg, Wen, Cp, Coresh, J, Gansevoort, Rt, Hemmelgarn, Br, Levey, As, Chronic, Kidney, Disease, Prognosis, Consortium, Wright, J, Appel, Lj, Greene, T, Astor, Bc, Chalmers, J, Macmahon, S, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Sang, Y, Atkins, Rc, Chadban, S, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Levin, A, Djurdjev, O, Sacks, Fm, Curhan, Gc, Shlipak, M, Peralta, C, Katz, R, Fried, Lf, Iso, H, Ohira, T, Kitamura, A, Yamagishi, K, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Townend, Jn, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Fox, Cs, Hwang, Sj, Meigs, Jb, Perkins, Rm, Fluck, N, Clark, Le, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasarød, K, Øien, Cm, Radtke, M, Irie, F, Sairenchi, T, Johnson, Es, Thorp, Ml, Weiss, Jw, Collins, Aj, Li, S, Chen, Sc, Vassalotti, Ja, Lee, Bj, Wetzels, Jf, Blankestijn, Pj, Van, Zuilen, Sarnak, M, Menon, V, Boer, De, Kramer, Hj, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, Jd, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Nakayama, M, Metoki, H, Kikuya, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, Jong, De, Bakker, Sj, Jassal, Sk, Barrett-Connor, E, Bergstrom, J, Heerspink, Hj, Zeeuw, De, D, Brenner, Be, Muntner, P, Judd, S, Mcclellan, W, Kimm, H, Jo, J, Mok, Y, Choi, E, Rossing, P, Parving, Hh, Tangri, N, Naimark, D, Wen, Sf, Tsao, Ck, Tsai, Mk, Ärnlöv, J, Larsson, A, Lannfelt, L, Bilo, Hj, Kleefstra, N, Groenier, Kh, Drion, I, Joosten, H, Ballew, Sh, Grams, M, Camarata, L, Hui, X, Seltzer, J, Winegrad, H., Matsushita, K, Mahmoodi, Bk, Woodward, M, Emberson, Jr, Jafar, Th, Jee, Sh, Polkinghorne, Kr, Shankar, A, Smith, Dh, Tonelli, M, Warnock, Dg, Wen, Cp, Coresh, J, Gansevoort, Rt, Hemmelgarn, Br, Levey, A, Chronic, Kidney, Disease, Prognosi, Consortium, Wright, J, Appel, Lj, Greene, T, Astor, Bc, Chalmers, J, Macmahon, S, Yatsuya, H, Yamashita, K, Toyoshima, H, Tamakoshi, K, Sang, Y, Atkins, Rc, Chadban, S, Klein, R, Klein, Be, Lee, Ke, Wang, H, Wang, F, Zhang, L, Zuo, L, Levin, A, Djurdjev, O, Sacks, Fm, Curhan, Gc, Shlipak, M, Peralta, C, Katz, R, Fried, Lf, Iso, H, Ohira, T, Kitamura, A, Yamagishi, K, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Landray, Mj, Townend, Jn, Wheeler, Dc, Rothenbacher, D, Brenner, H, Müller, H, Schöttker, B, Fox, C, Hwang, Sj, Meigs, Jb, Perkins, Rm, Fluck, N, Clark, Le, Prescott, Gj, Marks, A, Black, C, Cirillo, Massimo, Hallan, S, Aasarød, K, Øien, Cm, Radtke, M, Irie, F, Sairenchi, T, Johnson, E, Thorp, Ml, Weiss, Jw, Collins, Aj, Li, S, Chen, Sc, Vassalotti, Ja, Lee, Bj, Wetzels, Jf, Blankestijn, Pj, Van, Zuilen, Ad, Sarnak, M, Menon, V, De, Boer, Ih, Kramer, Hj, Kronenberg, F, Kollerits, B, Ritz, E, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, Jd, Froissart, M, Stengel, B, Metzger, M, Haymann, Jp, Houillier, P, Flamant, M, Ohkubo, T, Nakayama, M, Metoki, H, Kikuya, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, De, Jong, Pe, Bakker, Sj, Jassal, Sk, Barrett-Connor, E, Bergstrom, J, Heerspink, Hj, De, Zeeuw, D, Brenner, Be, Muntner, P, Judd, S, Mcclellan, W, Kimm, H, Jo, J, Mok, Y, Choi, E, Rossing, P, Parving, Hh, Tangri, N, Naimark, D, Wen, Sf, Tsao, Ck, Tsai, Mk, Ärnlöv, J, Larsson, A, Lannfelt, L, Bilo, Hj, Kleefstra, N, Groenier, Kh, Drion, I, Joosten, H, Ballew, Sh, Grams, M, Camarata, L, Hui, X, Seltzer, J, Winegrad, H., Cardiovascular Centre (CVC), and Groningen Kidney Center (GKC)

Subjects
CHRONIC KIDNEY-DISEASE, Gerontology, Male, EVALUATION PROGRAM KEEP, Population, Renal function, Black People, Ckd epi equation, urologic and male genital diseases, Risk Assessment, White People, Article, Decision Support Techniques, Cohort Studies, Sex Factors, Asian People, EPIDEMIOLOGY COLLABORATION EQUATION, Diabetes mellitus, CYSTATIN-C, Medicine, Humans, education, ALL-CAUSE MORTALITY, Cardiovascular mortality, Aged, Renal disorder [IGMD 9], GENERAL-POPULATION, education.field_of_study, business.industry, CARDIOVASCULAR RISK, Hazard ratio, STAGE RENAL-DISEASE, General Medicine, POPULATION COHORTS, Middle Aged, Models, Theoretical, medicine.disease, female genital diseases and pregnancy complications, Net reclassification improvement, SERUM CREATININE VALUES, Cardiovascular Diseases, Kidney Failure, Chronic, Female, business, Algorithms, Demography, Glomerular Filtration Rate
Abstract

Contains fulltext : 110640.pdf (Publisher’s version ) (Closed access) CONTEXT: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk implications in diverse settings is lacking. OBJECTIVE: To evaluate risk implications of estimated GFR using the CKD-EPI equation compared with the MDRD Study equation in populations with a broad range of demographic and clinical characteristics. DESIGN, SETTING, AND PARTICIPANTS: A meta-analysis of data from 1.1 million adults (aged >/= 18 years) from 25 general population cohorts, 7 high-risk cohorts (of vascular disease), and 13 CKD cohorts. Data transfer and analyses were conducted between March 2011 and March 2012. MAIN OUTCOME MEASURES: All-cause mortality (84,482 deaths from 40 cohorts), cardiovascular mortality (22,176 events from 28 cohorts), and end-stage renal disease (ESRD) (7644 events from 21 cohorts) during 9.4 million person-years of follow-up; the median of mean follow-up time across cohorts was 7.4 years (interquartile range, 4.2-10.5 years). RESULTS: Estimated GFR was classified into 6 categories (>/=90, 60-89, 45-59, 30-44, 15-29, and /=65 years), sex, race/ethnicity (white, Asian, and black), and presence or absence of diabetes and hypertension. The results in the high-risk and CKD cohorts were largely consistent with the general population cohorts. CONCLUSION: The CKD-EPI equation classified fewer individuals as having CKD and more accurately categorized the risk for mortality and ESRD than did the MDRD Study equation across a broad range of populations.

Published
2012

5. 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

Author

Astor, BC, Matsushita, K, Gansevoort, RT, van der Velde, M, Woodward, M, Levey, AS, Jong, PE, Coresh, J, de Jong, PE, El-Nahas, M, Eckardt, KU, Kasiske, BL, Wright, J, Appel, L, Greene, T, Levin, A, Djurdjev, O, Wheeler, DC, Landray, MJ, Townend, JN, Emberson, J, Clark, LE, Macleod, A, Marks, A, Ali, T, Fluck, N, Prescott, G, Smith, DH, Weinstein, JR, Johnson, ES, Thorp, ML, Wetzels, JF, Blankestijn, PJ, van Zuilen, AD, Menon, V, Sarnak, M, Beck, G, Kronenberg, F, Kollerits, B, Froissart, M, Stengel, B, Metzger, M, Remuzzi, G, Ruggenenti, P, Perna, A, Heerspink, HJ, Brenner, B, de Zeeuw, D, Rossing, P, Parving, HH, Auguste, P, Veldhuis, K, Wang, Y, Camarata, L, Thomas, B, Manley, T, Cardiovascular Centre (CVC), and Groningen Kidney Center (GKC)

Subjects
Male, PROGRESSION, Kidney, urologic and male genital diseases, Cohort Studies, Risk Factors, Renal disorder [IGMD 9], education.field_of_study, OUTCOMES, CARDIOVASCULAR RISK, Hazard ratio, Confounding, Middle Aged, Prognosis, female genital diseases and pregnancy complications, Nephrology, Disease Progression, Regression Analysis, Female, Kidney Diseases, epidemiology, TRIAL, medicine.symptom, epidemiology and outcomes, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Population, Renal function, Risk Assessment, Article, albuminuria, End stage renal disease, Predictive Value of Tests, Internal medicine, medicine, CKD, Humans, education, Aged, Proportional Hazards Models, Chi-Square Distribution, Proportional hazards model, business.industry, urogenital system, A300, medicine.disease, Creatine, Endocrinology, Albuminuria, Kidney Failure, Chronic, business, Biomarkers, chronic kidney disease, Kidney disease
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. Kidney International (2011) 79, 1331-1340; doi:10.1038/ki.2010.550; published online 2 February 2011

Published
2011
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6. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis

Author

Mahmoodi, Bk, Matsushita, K., Woodward, M., Blankestijn, Pj, Cirillo, Massimo, Ohkubo, T., Rossing, P., Sarnak, Mj, Stengel, B., Yamagishi, K., Yamashita, K., Zhang, L., Coresh, J., PE de Jong, Wright, BC Astor for the Chronic Kidney Disease Prognosis C. o. n. s. o. r. t. i. u. m. Investigators/Collaborators: J., Appel, L., Greene, T., Astor, Bc, Chalmers, J., Macmahon, S., Arima, H., Yatsuya, H., Toyoshima, H., Tamakoshi, K., Sang, Y., Atkins, R. C., Polkinghorne, Kr, Chadban, S., Shankar, A., Klein, R., Bek, Klein, Lee, Ke, Wang, H., Wang, F., Zuo, L., Levin, A., Djurdjev, O., Tonelli, M., Sacks, Fm, Curhan, Gc, Shlipak, M., Peralta, C., Katz, R., Fried, L., Iso, H., Kitamura, A., Ohira, T., Jafar, Th, Islam, M., Hatcher, J., Poulter, N., Chaturvedi, N., Landray, M. J., Emberson, Jr, Townend, Jn, Wheeler, Dc, Rothenbacher, D., Brenner, H., Muller, H., Schottker, B., Fox, Cs, Hwang, S. J., Meigs, Jb, Perkins, Rm, Fluck, N., Clark, Le, Prescott, Gj, Marks, A., Black, C., Hallan, S., Aasarod, K., Oien, Cm, Radtke, M., Irie, F., Sairenchi, T., Smith, Dh, Weiss, Jw, Johnson, Es, Thorp, Ml, Collins, Aj, Vassalotti, Ja, Li, S., Chen, S. C., Lee, Bj, Wetzels, Jf, AD van Zuilen, Sarnak, M., Levey, As, Menon, V., Kramer, Hj, IH de Boer, Kronenberg, F., Kollerits, B., Roderick, E. R. i. t. z. P., Nitsch, D., Fletcher, A., Bulpitt, C., Ishani, A., Neaton, Jd, Froissart, M., Metzger, M., Haymann, J. P., Houillier, P., Flamant, M., Metoki, H., Nakayama, M., Kikuya, M., Imai, Y., Iseki, K., Nelson, Rg, Knowler, Wc, Gansevoort, Rt, Hillege, H., Jassal, Sk, Barrett Connor, E., Bergstrom, J., HJ Lambers Heerspink, Brenner, Be, de Zeeuw, D., Warnock, Dg, Muntner, P., Judd, S., Mcclellan, W., Jee, Sh, Kimm, H., Jo, J., Mok, Y., Parving, H. H., Tangri, N., Naimark, D., Wen, C. P., Wen, S. F., Tsao, C. K., Tsai, M. K., Arnlov, J., Lannfelt, L., Larsson, A., Bilo, Hj, Joosten, H., Kleefstra, N., Groenier, Kh, Steering Committee: BC Astor, I. D. r. i. o. n., Hemmelgarn, Br, Data Coordinating Center: SH Ballew, M. W. o. o. d. w. a. r. d., Grams, M., Camarata, L., Hui, X., Seltzer, J., Winegrad, H., Mahmoodi, Bk, Matsushita, K, Woodward, M, Blankestijn, Pj, Cirillo, M, Ohkubo, T, Rossing, P, Sarnak, Mj, Stengel, B, Yamagishi, K, Yamashita, K, Zhang, L, Coresh, J, de Jong, Pe, Investigators/Collaborators: J Wright, BC Astor for the Chronic Kidney Disease Prognosis Consortium., Appel, L, Greene, T, Astor, Bc, Chalmers, J, Macmahon, S, Arima, H, Yatsuya, H, Toyoshima, H, Tamakoshi, K, Sang, Y, C Atkins, R, Polkinghorne, Kr, Chadban, S, Shankar, A, Klein, R, Klein, Bek, Lee, Ke, Wang, H, Wang, F, Zuo, L, Levin, A, Djurdjev, O, Tonelli, M, Sacks, Fm, Curhan, Gc, Shlipak, M, Peralta, C, Katz, R, Fried, L, Iso, H, Kitamura, A, Ohira, T, Jafar, Th, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, J Landray, M, Emberson, Jr, Townend, Jn, Wheeler, Dc, Rothenbacher, D, Brenner, H, Muller, H, Schottker, B, Fox, C, Hwang, S-J, Meigs, Jb, Perkins, Rm, Fluck, N, Clark, Le, Prescott, Gj, Marks, A, Black, C, Hallan, S, Aasarod, K, Oien, Cm, Radtke, M, Irie, F, Sairenchi, T, Smith, Dh, Weiss, Jw, Johnson, E, Thorp, Ml, Collins, Aj, Vassalotti, Ja, Li, S, Chen, S-C, Lee, Bj, Wetzels, Jf, van Zuilen, Ad, Sarnak, M, Levey, A, Menon, V, Kramer, Hj, de Boer, Ih, Kronenberg, F, Kollerits, B, P Roderick, E Ritz., Nitsch, D, Fletcher, A, Bulpitt, C, Ishani, A, Neaton, Jd, Froissart, M, Metzger, M, Haymann, J-P, Houillier, P, Flamant, M, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Iseki, K, Nelson, Rg, Knowler, Wc, Gansevoort, Rt, Hillege, H, Jassal, Sk, Barrett-Connor, E, Bergstrom, J, Lambers Heerspink, Hj, Brenner, Be, de Zeeuw, D, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, W, Jee, Sh, Kimm, H, Jo, J, Mok, Y, Parving, H-H, Tangri, N, Naimark, D, Wen, C-P, Wen, S-F, Tsao, C-K, Tsai, M-K, Arnlov, J, Lannfelt, L, Larsson, A, Bilo, Hj, Joosten, H, Kleefstra, N, Groenier, Kh, Steering Committee: BC Astor, I Drion., Hemmelgarn, Br, Data Coordinating Center: SH Ballew, M Woodward., Grams, M, Camarata, L, Hui, X, Seltzer, J, and Winegrad., H

Subjects
Male, medicine.medical_specialty, hypertension, Blood Pressure, BLOOD-PRESSURE, GLOMERULAR-FILTRATION-RATE, Article, albuminuria, DIABETIC-NEPHROPATHY, End stage renal disease, CKD-PC Consortium, Risk Factors, Cause of Death, Internal medicine, REVERSE EPIDEMIOLOGY, eGFR, EQUATION, medicine, Humans, Intensive care medicine, Aged, Proportional Hazards Models, ALL-CAUSE MORTALITY, Renal disorder [IGMD 9], Aged, 80 and over, end-stage renal disease, business.industry, General Medicine, Middle Aged, medicine.disease, mortality, RISK POPULATION COHORTS, PREVALENCE, Chronic Disease, COLLABORATIVE METAANALYSIS, Kidney Failure, Chronic, Female, HIGHER ALBUMINURIA, business, Glomerular Filtration Rate, Kidney disease
Abstract

Item does not contain fulltext BACKGROUND: Hypertension is the most prevalent comorbidity in individuals with chronic kidney disease. However, whether the association of the kidney disease measures, estimated glomerular filtration rate (eGFR) and albuminuria, with mortality or end-stage renal disease (ESRD) differs by hypertensive status is unknown. METHODS: We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and ESRD associated with eGFR and albuminuria in individuals with and without hypertension. FINDINGS: We analysed data for 45 cohorts (25 general population, seven high-risk, and 13 chronic kidney disease) with 1,127,656 participants, 364,344 of whom had hypertension. Low eGFR and high albuminuria were associated with mortality irrespective of hypertensive status in the general population and high-risk cohorts. All-cause mortality risk was 1.1-1.2 times higher in individuals with hypertension than in those without hypertension at preserved eGFR. A steeper relative risk gradient in individuals without hypertension than in those with hypertension at eGFR range 45-75 mL/min per 1.73 m(2) led to much the same mortality risk at lower eGFR. With a reference eGFR of 95 mL/min per 1.73 m(2) in each group to explicitly assess interaction, adjusted HR for all-cause mortality at eGFR 45 mL/min per 1.73 m(2) was 1.77 (95% CI 1.57-1.99) in individuals without hypertension versus 1.24 (1.11-1.39) in those with hypertension (p for overall interaction=0.0003). Similarly, for albumin-creatinine ratio of 300 mg/g (vs 5 mg/g), HR was 2.30 (1.98-2.68) in individuals without hypertension versus 2.08 (1.84-2.35) in those with hypertension (p for overall interaction=0.019). We recorded much the same results for cardiovascular mortality. The associations of eGFR and albuminuria with ESRD, however, did not differ by hypertensive status. Results for chronic kidney disease cohorts were similar to those for general and high-risk population cohorts. INTERPRETATION: Chronic kidney disease should be regarded as at least an equally relevant risk factor for mortality and ESRD in individuals without hypertension as it is in those with hypertension. FUNDING: US National Kidney Foundation.

Published
2012

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

Author

Chronic Kidney Disease Prognosis Consortium, Matsushita, K, van der Velde, M, Astor, Bc, Woodward, M, Levey, As, de Jong PE, Coresh, J, Investigators/Collaborators: Levey AS, Gansevoort R. T., El Nahas, M, Eckardt, Ku, Kasiske, Bl, Tonelli, M, Hemmelgarn, B, Wang, Y, Atkins, Rc, Polkinghorne, Kr, Chadban, Sj, Shankar, A, Klein, R, Klein, Be, Wang, H, Wang, F, Zhang, L, Liu, L, Shlipak, M, Sarnak, Mj, Katz, R, Fried, Lp, Jafar, T, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Rothenbacher, D, Brenner, H, Raum, E, Koenig, W, Fox, Cs, Hwang, Sj, Meigs, Jb, Cirillo, Massimo, Hallan, S, Lydersen, S, Holmen, J, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Gansevoort, Rt, Jassal, Sk, Barrett Connor, E, Bergstrom, J, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, Wm, Cushman, M, Howard, G, Mcclure, La, Jee, Sh, Kimm, H, Yun, Je, Wen, Cp, Wen, Sf, Tsao, Ck, Tsai, Mk, Arnlöv, J, Auguste, P, Veldhuis, K, Camarata, L, Thomas, B, Manley, T., Chronic Kidney Disease Prognosis, Consortium, Matsushita, K, van der Velde, M, Astor, Bc, Woodward, M, Levey, A, de Jong, Pe, Coresh, J, Investigators/Collaborators: Levey AS, Gansevoort R. T., El Nahas, M, Eckardt, Ku, Kasiske, Bl, Tonelli, M, Hemmelgarn, B, Wang, Y, Atkins, Rc, Polkinghorne, Kr, Chadban, Sj, Shankar, A, Klein, R, Klein, Be, Wang, H, Wang, F, Zhang, L, Liu, L, Shlipak, M, Sarnak, Mj, Katz, R, Fried, Lp, Jafar, T, Islam, M, Hatcher, J, Poulter, N, Chaturvedi, N, Rothenbacher, D, Brenner, H, Raum, E, Koenig, W, Fox, C, Hwang, Sj, Meigs, Jb, Cirillo, Massimo, Hallan, S, Lydersen, S, Holmen, J, Roderick, P, Nitsch, D, Fletcher, A, Bulpitt, C, Ohkubo, T, Metoki, H, Nakayama, M, Kikuya, M, Imai, Y, Gansevoort, Rt, Jassal, Sk, Barrett Connor, E, Bergstrom, J, Warnock, Dg, Muntner, P, Judd, S, Mcclellan, Wm, Cushman, M, Howard, G, Mcclure, La, Jee, Sh, Kimm, H, Yun, Je, Wen, Cp, Wen, Sf, Tsao, Ck, Tsai, Mk, Arnlöv, J, Auguste, P, Veldhuis, K, Camarata, L, Thomas, B, Manley, T., Cardiovascular Centre (CVC), and Groningen Kidney Center (GKC)

Subjects
Male, CHRONIC KIDNEY-DISEASE, medicine.medical_specialty, Pathology, Population, Urology, Renal function, POOLED ANALYSIS, chemistry.chemical_compound, RISK-FACTOR, CYSTATIN-C, medicine, Risk of mortality, EQUATION, Albuminuria, Humans, Risk factor, Mortality, education, OLDER-ADULTS, Aged, Proportional Hazards Models, Creatinine, education.field_of_study, OUTCOMES, SERUM CREATININE, business.industry, Hazard ratio, General Medicine, Middle Aged, medicine.disease, PREVALENCE, RENAL-DISEASE, chemistry, Cardiovascular Diseases, Chronic Disease, Female, Kidney Diseases, medicine.symptom, business, Kidney disease, Glomerular Filtration Rate
Abstract

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 m(2) and 105 mL/min/1.73 m(2) and increased at lower eGFRs. Compared with eGFR 95 mL/min/1.73 m(2), adjusted HRs for all-cause mortality were 1.18 (95% CI 1.05-1.32) for eGFR 60 mL/min/1.73 m(2), 1.57 (1.39-1.78) for 45 mL/min/1.73 m(2), and 3.14 (2.39-4.13) for 15 mL/min/1.73 m(2). 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 m(2) 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.

Published
2010

8. 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

Author

Astor, B.C., Matsushita, K., Gansevoort, R.T., Velde, M. van de, Woodward, M., Levey, A.S., Jong, P.E. de, Coresh, J., El-Nahas, M., Eckardt, K.U., Kasiske, B.L., Wright, J., Appel, L., Greene, T., Levin, A., Djurdjev, O., Wheeler, D.C., Landray, M.J., Townend, J.N., Emberson, J., Clark, L.E., Macleod, A., Marks, A., Ali, T., Fluck, N., Prescott, G., Smith, D.H., Weinstein, J.R., Johnson, E.S., Thorp, M.L., Wetzels, J.F.M., Blankestijn, P.J., Zuilen, A.D. van, Menon, V., Sarnak, M., Beck, G., Kronenberg, F., Kollerits, B., Froissart, M., Stengel, B., Metzger, M., Remuzzi, G., Ruggenenti, P., Perna, A., Heerspink, H.J., Brenner, B., Zeeuw, D. de, Rossing, P., Parving, H.H., Auguste, P., Veldhuis, K., Wang, Y., Camarata, L., Thomas, B., Manley, T., Astor, B.C., Matsushita, K., Gansevoort, R.T., Velde, M. van de, Woodward, M., Levey, A.S., Jong, P.E. de, Coresh, J., El-Nahas, M., Eckardt, K.U., Kasiske, B.L., Wright, J., Appel, L., Greene, T., Levin, A., Djurdjev, O., Wheeler, D.C., Landray, M.J., Townend, J.N., Emberson, J., Clark, L.E., Macleod, A., Marks, A., Ali, T., Fluck, N., Prescott, G., Smith, D.H., Weinstein, J.R., Johnson, E.S., Thorp, M.L., Wetzels, J.F.M., Blankestijn, P.J., Zuilen, A.D. van, Menon, V., Sarnak, M., Beck, G., Kronenberg, F., Kollerits, B., Froissart, M., Stengel, B., Metzger, M., Remuzzi, G., Ruggenenti, P., Perna, A., Heerspink, H.J., Brenner, B., Zeeuw, D. de, Rossing, P., Parving, H.H., Auguste, P., Veldhuis, K., Wang, Y., Camarata, L., Thomas, B., and Manley, T.

Abstract

Item does not contain fulltext, 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.

Published
2011

9. Recommendations to the Society for Epidemiologic Research for Further Promoting Diversity and Inclusion at the Annual Meeting and Beyond.

Author

Zhang M, Jarrett BA, Althoff KN, Burman FS, Camarata L, Coburn SB, Dickerson AS, Foti K, Kaur M, Leifheit KM, Malone J, Moore EA, Mouslim MC, Prata Menezes N, Robsky K, Tang O, Wallace AS, and Dean LT

Subjects
Epidemiologic Research Design, Humans, Congresses as Topic, Cultural Diversity, Epidemiology organization & administration
Abstract

Increasing diverse engagement in the Society for Epidemiologic Research (SER) will positively impact the field of epidemiology. As the largest and longest-running epidemiologic society in North America, SER has long been a pioneer in promoting diversity and inclusion. A recent survey of SER members, however, showed there is still room for improving diversity, inclusion, representation, and participation in the Society. In this commentary, as members of both the SER and the Johns Hopkins Bloomberg School of Public Health Department of Epidemiology's Inclusion, Diversity, Equity, Anti-Racism, and Science (Epi IDEAS) Working Group, we recommend 4 goals for the SER Annual Meeting and beyond: 1) convene epidemiologic researchers with diverse backgrounds and ideas; 2) promote an inclusive environment at the SER Annual Meeting; 3) develop, compile, and disseminate best practices to honor diversity in epidemiologic research; and 4) increase prioritization of health disparities research and methods. We also suggest strategies for achieving these goals so that SER can better include, support, and elevate members from historically disadvantaged groups. While our recommendations are tailored specifically to SER, the greater epidemiologic and academic communities could benefit from adopting these goals and strategies within their professional societies and conferences., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2020
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10. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts.

Author

van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey A, de Jong P, Gansevoort RT, van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey AS, de Jong PE, Gansevoort RT, Levey A, El-Nahas M, Eckardt KU, Kasiske BL, Ninomiya T, Chalmers J, Macmahon S, Tonelli M, Hemmelgarn B, Sacks F, Curhan G, Collins AJ, Li S, Chen SC, Hawaii Cohort KP, Lee BJ, Ishani A, Neaton J, Svendsen K, Mann JF, Yusuf S, Teo KK, Gao P, Nelson RG, Knowler WC, Bilo HJ, Joosten H, Kleefstra N, Groenier KH, Auguste P, Veldhuis K, Wang Y, Camarata L, Thomas B, and Manley T

Subjects
Adult, Aged, Albuminuria diagnosis, Albuminuria etiology, Albuminuria physiopathology, Biomarkers blood, Biomarkers urine, Cardiovascular Diseases diagnosis, Cardiovascular Diseases etiology, Cause of Death, Chi-Square Distribution, Cohort Studies, Creatine blood, Disease Progression, Female, Humans, Kidney Diseases complications, Kidney Diseases diagnosis, Kidney Diseases physiopathology, Male, Middle Aged, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Regression Analysis, Risk Assessment, Risk Factors, Albuminuria mortality, Cardiovascular Diseases mortality, Glomerular Filtration Rate, Kidney physiopathology, Kidney Diseases mortality
Abstract

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 m², but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m² 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.

Published
2011
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