Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis.
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Writing Group for the CKD Prognosis Consortium, Grams Morgan E, Coresh Josef, Matsushita Kunihiro, Ballew Shoshana H, Sang Yingying, Surapaneni Aditya, Alencar de Pinho Natalia, Anderson Amanda, Appel Lawrence J, Ärnlöv Johan, Azizi Fereidoun, Bansal Nisha, Bell Samira, Bilo Henk J G, Brunskill Nigel J, Carrero Juan J, Chadban Steve, Chalmers John, Chen Jing, Ciemins Elizabeth, Cirillo Massimo, Ebert Natalie, Evans Marie, Ferreiro Alejandro, Fu Edouard L, Fukagawa Masafumi, Green Jamie A, Gutierrez Orlando M, Herrington William G, Hwang Shih-Jen, Inker Lesley A, Iseki Kunitoshi, Jafar Tazeen, Jassal Simerjot K, Jha Vivekanand, Kadota Aya, Katz Ronit, Köttgen Anna, Konta Tsuneo, Kronenberg Florian, Lee Brian J, Lees Jennifer, Levin Adeera, Looker Helen C, Major Rupert, Melzer Cohen Cheli, Mieno Makiko, Miyazaki Mariko, Moranne Olivier, Muraki Isao, Naimark David, Nitsch Dorothea, Oh Wonsuk, Pena Michelle, Purnell Tanjala S, Sabanayagam Charumathi, Satoh Michihiro, Sawhney Simon, Schaeffner Elke, Schöttker Ben, Shen Jenny I, Shlipak Michael G, Sinha Smeeta, Stengel Benedicte, Sumida Keiichi, Tonelli Marcello, Valdivielso Jose M, van Zuilen Arjan D, Visseren Frank L J, Wang Angela Yee-Moon, Wen Chi-Pang, Wheeler David C, Yatsuya Hiroshi, Yamagata Kunihiro, Yang Jae Won, Young Ann, Zhang Haitao, Zhang Luxia, Levey Andrew S, Gansevoort Ron T
Аннотация
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 associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]).
CONCLUSIONS AND RELEVANCE: In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.