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.
Astor BC., Matsushita K., Gansevoort RT., van der Velde M., Woodward M., Levey AS., Jong PE., Coresh J., Chronic Kidney Disease Prognosis Consortium None., Astor BC., Matsushita K., Gansevoort RT., van der Velde M., Woodward M., Levey AS., de Jong PE., Coresh J., 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.
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.