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

Grams ME, Coresh J, Matsushita K, Ballew SH, Sang Y, Surapaneni A, Alencar De Pinho N, Anderson A, Appel LJ, Arnlöv J, Azizi F, Bansal N, Bell S, Bilo HJ, Brunskill NJ, Carrero JJ, Chadban S, Chalmers J, Chen J, Ciemins E, Cirillo M, Ebert N, Evans M, Ferreiro A, Fu EL, Fukagawa M, Green JA, Gutierrez OM, Herrington WG, Hwang SJ, Inker LA, Iseki K, Jafar T, Jassal SK, Jha V, Kadota A, Katz R, Köttgen A, Konta T, Kronenberg F, Lee BJ, Lees J, Levin A, Looker HC, Major R, Melzer Cohen C, Mieno M, Miyazaki M, Moranne O, Muraki I, Naimark D, Nitsch D, Oh W, Pena M, Purnell TS, Sabanayagam C, Satoh M, Sawhney S, Schaeffner E, Schöttker B, Shen JI, Shlipak MG, Sinha S, Stengel B, Sumida K, Tonelli M, Valdivielso JM, Van Zuilen AD, Visseren FL, Wang AYM, Wen CP, Wheeler DC, Yatsuya H, Yamagata K, Yang JW, Young A, Zhang H, Zhang L, Levey AS, Gansevoort RT (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 330

Pages Range: 1266-1277

Journal Issue: 13

DOI: 10.1001/jama.2023.17002

Abstract

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 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.

Involved external institutions

The Welch Center for Prevention, Epidemiology and Clinical Research United States (USA) (US) New York University (NYU) United States (USA) (US) American Medical Group Association (AMGA) United States (USA) (US) Università degli Studi di Salerno Italy (IT) Research Center in Epidemiology and Population Health / Centre de recherche en Epidémiologie et Santé des Populations (CESP) France (FR) Charité - Universitätsmedizin Berlin Germany (DE) Karolinska University Hospital / Karolinska Universitetssjukhuset Sweden (SE) University of the Republic / Universidad de la República (UdelaR) Uruguay (UY) Tulane University United States (USA) (US) Dalarna University College Sweden (SE) Harvard University United States (USA) (US) Tokai University / 東海大学 (Tōkai Daigaku) Japan (JP) Geisinger Commonwealth School of Medicine (GCSOM) United States (USA) (US) University of Washington United States (USA) (US) Cardiology PC United Kingdom (GB) University of Oxford United Kingdom (GB) University of Dundee United Kingdom (GB) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) London School of Hygiene and Tropical Medicine United Kingdom (GB) Icahn School of Medicine at Mount Sinai United States (USA) (US) University College London (UCL) United Kingdom (GB) Universitätsklinikum Freiburg Germany (DE) National University of Singapore (NUS) Singapore (SG) Tohoku Medical and Pharmaceutical University Japan (JP) University of Aberdeen United Kingdom (GB) Deutsches Krebsforschungszentrum (DKFZ) Germany (DE) University of California Los Angeles (UCLA) United States (USA) (US) University of California San Francisco (UCSF) United States (USA) (US) Salford Royal Hospital United Kingdom (GB) The University of Tennessee Health Science Center United States (USA) (US) University of Calgary Canada (CA) Institut de Recerca Biomèdica de Lleida (IRBLleida) Spain (ES) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Nagoya University / 名古屋大学 Japan (JP) University of Tsukuba / 筑波大学 Japan (JP) St. Michael's Hospital Canada (CA) Nanjing University China (CN) Peking University First Hospital / 北大国际医院 China (CN) Tufts Medical Center United States (USA) (US) University of Hong Kong (HKU) / 香港大學 Hong Kong (HK) National Health Research Institutes (NHRI) / 國家衛生研究院 Taiwan (TW) University of Leicester United Kingdom (GB) Danderyds sjukhus Sweden (SE) Framingham Heart Study United States (USA) (US) Duke-NUS Medical School / 杜克—国大医学研究生院 Singapore (SG) Royal Prince Alfred Hospital Australia (AU) University of New South Wales (UNSW) Australia (AU) University of California, San Diego United States (USA) (US) The George Institute for Global Health Australia (AU) Yamagata University (YU) Japan (JP) Maccabi Institute for Health Services Research Israel (IL) Jichi Medical University / 自治医科大学 Japan (JP) Centre Hospitalier Universitaire Carémeau France (FR) University of Toronto Canada (CA) Shiga University of Medical Science Japan (JP) Medizinische Universität Innsbruck Austria (AT) Kaiser Permanente United States (USA) (US) University of Glasgow United Kingdom (GB) University of British Columbia Canada (CA) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK / NIDDKD) United States (USA) (US)

How to cite

APA:

Grams, M.E., Coresh, J., Matsushita, K., Ballew, S.H., Sang, Y., Surapaneni, A.,... Gansevoort, R.T. (2023). Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis. Journal of the American Medical Association, 330(13), 1266-1277. https://doi.org/10.1001/jama.2023.17002

MLA:

Grams, Morgan E., et al. "Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis." Journal of the American Medical Association 330.13 (2023): 1266-1277.

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