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Glomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease

Chronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most cli... Full description

Journal Title: Nature medicine 2019-11, Vol.25 (11), p.1753-1760
Main Author: Lees, Jennifer S
Other Authors: Welsh, Claire E , Celis-Morales, Carlos A , Mackay, Daniel , Lewsey, James , Gray, Stuart R , Lyall, Donald M , Cleland, John G , Gill, Jason M R , Jhund, Pardeep S , Pell, Jill , Sattar, Naveed , Welsh, Paul , Mark, Patrick B
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: United States: Nature Publishing Group
ID: ISSN: 1078-8956
Link: https://www.ncbi.nlm.nih.gov/pubmed/31700174
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title: Glomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease
format: Article
creator:
  • Lees, Jennifer S
  • Welsh, Claire E
  • Celis-Morales, Carlos A
  • Mackay, Daniel
  • Lewsey, James
  • Gray, Stuart R
  • Lyall, Donald M
  • Cleland, John G
  • Gill, Jason M R
  • Jhund, Pardeep S
  • Pell, Jill
  • Sattar, Naveed
  • Welsh, Paul
  • Mark, Patrick B
subjects:
  • Adult
  • Aged
  • Albuminuria - complications
  • Albuminuria - diagnosis
  • Albuminuria - physiopathology
  • Albuminuria - urine
  • Arteriosclerosis
  • Atherosclerosis
  • Biological Specimen Banks
  • Biomarkers - blood
  • Biomarkers - urine
  • Cardiovascular disease
  • Cardiovascular diseases
  • Cardiovascular Diseases - blood
  • Cardiovascular Diseases - complications
  • Cardiovascular Diseases - diagnosis
  • Cardiovascular Diseases - physiopathology
  • Care and treatment
  • Creatinine
  • Creatinine - metabolism
  • Cystatin
  • Cystatin C
  • End-stage renal disease
  • Epidermal growth factor receptors
  • Female
  • Glomerular filtration rate
  • Glomerular Filtration Rate - physiology
  • Health risk assessment
  • Health risks
  • Heart diseases
  • Humans
  • Kidney diseases
  • Kidney Failure, Chronic - blood
  • Kidney Failure, Chronic - diagnosis
  • Kidney Failure, Chronic - physiopathology
  • Kidneys
  • Male
  • Medical research
  • Medicine, Experimental
  • Middle Aged
  • Mortality
  • Prediction models
  • Prevention
  • Reclassification
  • Renal Insufficiency, Chronic - complications
  • Renal Insufficiency, Chronic - diagnosis
  • Renal Insufficiency, Chronic - physiopathology
  • Risk analysis
  • Risk assessment
  • Risk Factors
ispartof: Nature medicine, 2019-11, Vol.25 (11), p.1753-1760
description: Chronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.
language: eng
source:
identifier: ISSN: 1078-8956
fulltext: no_fulltext
issn:
  • 1078-8956
  • 1546-170X
url: Link


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titleGlomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease
creatorLees, Jennifer S ; Welsh, Claire E ; Celis-Morales, Carlos A ; Mackay, Daniel ; Lewsey, James ; Gray, Stuart R ; Lyall, Donald M ; Cleland, John G ; Gill, Jason M R ; Jhund, Pardeep S ; Pell, Jill ; Sattar, Naveed ; Welsh, Paul ; Mark, Patrick B
creatorcontribLees, Jennifer S ; Welsh, Claire E ; Celis-Morales, Carlos A ; Mackay, Daniel ; Lewsey, James ; Gray, Stuart R ; Lyall, Donald M ; Cleland, John G ; Gill, Jason M R ; Jhund, Pardeep S ; Pell, Jill ; Sattar, Naveed ; Welsh, Paul ; Mark, Patrick B
descriptionChronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.
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subjectAdult ; Aged ; Albuminuria - complications ; Albuminuria - diagnosis ; Albuminuria - physiopathology ; Albuminuria - urine ; Arteriosclerosis ; Atherosclerosis ; Biological Specimen Banks ; Biomarkers - blood ; Biomarkers - urine ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - physiopathology ; Care and treatment ; Creatinine ; Creatinine - metabolism ; Cystatin ; Cystatin C ; End-stage renal disease ; Epidermal growth factor receptors ; Female ; Glomerular filtration rate ; Glomerular Filtration Rate - physiology ; Health risk assessment ; Health risks ; Heart diseases ; Humans ; Kidney diseases ; Kidney Failure, Chronic - blood ; Kidney Failure, Chronic - diagnosis ; Kidney Failure, Chronic - physiopathology ; Kidneys ; Male ; Medical research ; Medicine, Experimental ; Middle Aged ; Mortality ; Prediction models ; Prevention ; Reclassification ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - physiopathology ; Risk analysis ; Risk assessment ; Risk Factors
ispartofNature medicine, 2019-11, Vol.25 (11), p.1753-1760
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8Gill, Jason M R
9Jhund, Pardeep S
10Pell, Jill
11Sattar, Naveed
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descriptionChronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.
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2Albuminuria - complications
3Albuminuria - diagnosis
4Albuminuria - physiopathology
5Albuminuria - urine
6Arteriosclerosis
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8Biological Specimen Banks
9Biomarkers - blood
10Biomarkers - urine
11Cardiovascular disease
12Cardiovascular diseases
13Cardiovascular Diseases - blood
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16Cardiovascular Diseases - physiopathology
17Care and treatment
18Creatinine
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20Cystatin
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23Epidermal growth factor receptors
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25Glomerular filtration rate
26Glomerular Filtration Rate - physiology
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33Kidney Failure, Chronic - diagnosis
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38Medicine, Experimental
39Middle Aged
40Mortality
41Prediction models
42Prevention
43Reclassification
44Renal Insufficiency, Chronic - complications
45Renal Insufficiency, Chronic - diagnosis
46Renal Insufficiency, Chronic - physiopathology
47Risk analysis
48Risk assessment
49Risk Factors
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titleGlomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease
authorLees, Jennifer S ; Welsh, Claire E ; Celis-Morales, Carlos A ; Mackay, Daniel ; Lewsey, James ; Gray, Stuart R ; Lyall, Donald M ; Cleland, John G ; Gill, Jason M R ; Jhund, Pardeep S ; Pell, Jill ; Sattar, Naveed ; Welsh, Paul ; Mark, Patrick B
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45Renal Insufficiency, Chronic - diagnosis
46Renal Insufficiency, Chronic - physiopathology
47Risk analysis
48Risk assessment
49Risk Factors
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abstractChronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.
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