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

Summary 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.... Full description

Journal Title: The Lancet (British edition) 2010, Vol.375 (9731), p.2073-2081
Main Author: Matsushita, Kunihiro
Other Authors: van der Velde, Marije , Astor, Brad C , Woodward, Mark , Levey, Anew S , de Jong, Paul E , Coresh, Josef , Gansevoort, Ron T
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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recordid: cdi_swepub_primary_oai_prod_swepub_kib_ki_se_120865197
title: Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
format: Article
creator:
  • Matsushita, Kunihiro
  • van der Velde, Marije
  • Astor, Brad C
  • Woodward, Mark
  • Levey, Anew S
  • de Jong, Paul E
  • Coresh, Josef
  • Gansevoort, Ron T
subjects:
  • Abridged Index Medicus
  • Aged
  • Albuminuria - complications
  • Associated diseases and complications
  • Biological and medical sciences
  • Cardiovascular disease
  • Cardiovascular Diseases - mortality
  • Cardiovascular Diseases - physiopathology
  • Chronic Disease
  • CHRONIC KIDNEY-DISEASE
  • Creatinine - urine
  • CYSTATIN-C
  • Diabetes
  • Diabetes. Impaired glucose tolerance
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • EQUATION
  • Female
  • General aspects
  • Glomerular Filtration Rate
  • Humans
  • Internal Medicine
  • Kidney diseases
  • Kidney Diseases - physiopathology
  • Kidneys
  • Male
  • Medical and Health Sciences
  • Medical sciences
  • Medicin och hälsovetenskap
  • Middle Aged
  • Mortality
  • Nephrology. Urinary tract diseases
  • Older people
  • OLDER-ADULTS
  • OUTCOMES
  • POOLED ANALYSIS
  • PREVALENCE
  • Proportional Hazards Models
  • RENAL-DISEASE
  • RISK-FACTOR
  • SERUM CREATININE
  • Studies
  • Systematic review
  • Urinary system involvement in other diseases. Miscellaneous
ispartof: The Lancet (British edition), 2010, Vol.375 (9731), p.2073-2081
description: Summary 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 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2 , adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05–1·32) for eGFR 60 mL/min/1·73 m2 , 1·57 (1·39–1·78) for 45 mL/min/1·73 m2 , and 3·14 (2·39–4·13) for 15 mL/min/1·73 m2 . 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 m2 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.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
  • 1474-547X
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titleAssociation of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
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creatorMatsushita, Kunihiro ; van der Velde, Marije ; Astor, Brad C ; Woodward, Mark ; Levey, Anew S ; de Jong, Paul E ; Coresh, Josef ; Gansevoort, Ron T
creatorcontribMatsushita, Kunihiro ; van der Velde, Marije ; Astor, Brad C ; Woodward, Mark ; Levey, Anew S ; de Jong, Paul E ; Coresh, Josef ; Gansevoort, Ron T ; Chronic Kidney Disease Prognosis Consortium
descriptionSummary 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 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2 , adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05–1·32) for eGFR 60 mL/min/1·73 m2 , 1·57 (1·39–1·78) for 45 mL/min/1·73 m2 , and 3·14 (2·39–4·13) for 15 mL/min/1·73 m2 . 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 m2 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.
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0ISSN: 0140-6736
1ISSN: 1474-547X
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4PMID: 20483451
5CODEN: LANCAO
languageeng
publisherKidlington: Elsevier Ltd
subjectAbridged Index Medicus ; Aged ; Albuminuria - complications ; Associated diseases and complications ; Biological and medical sciences ; Cardiovascular disease ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - physiopathology ; Chronic Disease ; CHRONIC KIDNEY-DISEASE ; Creatinine - urine ; CYSTATIN-C ; Diabetes ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; EQUATION ; Female ; General aspects ; Glomerular Filtration Rate ; Humans ; Internal Medicine ; Kidney diseases ; Kidney Diseases - physiopathology ; Kidneys ; Male ; Medical and Health Sciences ; Medical sciences ; Medicin och hälsovetenskap ; Middle Aged ; Mortality ; Nephrology. Urinary tract diseases ; Older people ; OLDER-ADULTS ; OUTCOMES ; POOLED ANALYSIS ; PREVALENCE ; Proportional Hazards Models ; RENAL-DISEASE ; RISK-FACTOR ; SERUM CREATININE ; Studies ; Systematic review ; Urinary system involvement in other diseases. Miscellaneous
ispartofThe Lancet (British edition), 2010, Vol.375 (9731), p.2073-2081
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0Matsushita, Kunihiro
1van der Velde, Marije
2Astor, Brad C
3Woodward, Mark
4Levey, Anew S
5de Jong, Paul E
6Coresh, Josef
7Gansevoort, Ron T
8Chronic Kidney Disease Prognosis Consortium
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0Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
1The Lancet (British edition)
addtitleLancet
descriptionSummary 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 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2 , adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05–1·32) for eGFR 60 mL/min/1·73 m2 , 1·57 (1·39–1·78) for 45 mL/min/1·73 m2 , and 3·14 (2·39–4·13) for 15 mL/min/1·73 m2 . 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 m2 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.
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2Albuminuria - complications
3Associated diseases and complications
4Biological and medical sciences
5Cardiovascular disease
6Cardiovascular Diseases - mortality
7Cardiovascular Diseases - physiopathology
8Chronic Disease
9CHRONIC KIDNEY-DISEASE
10Creatinine - urine
11CYSTATIN-C
12Diabetes
13Diabetes. Impaired glucose tolerance
14Endocrine pancreas. Apud cells (diseases)
15Endocrinopathies
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17Female
18General aspects
19Glomerular Filtration Rate
20Humans
21Internal Medicine
22Kidney diseases
23Kidney Diseases - physiopathology
24Kidneys
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26Medical and Health Sciences
27Medical sciences
28Medicin och hälsovetenskap
29Middle Aged
30Mortality
31Nephrology. Urinary tract diseases
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34OUTCOMES
35POOLED ANALYSIS
36PREVALENCE
37Proportional Hazards Models
38RENAL-DISEASE
39RISK-FACTOR
40SERUM CREATININE
41Studies
42Systematic review
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titleAssociation of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
authorMatsushita, Kunihiro ; van der Velde, Marije ; Astor, Brad C ; Woodward, Mark ; Levey, Anew S ; de Jong, Paul E ; Coresh, Josef ; Gansevoort, Ron T
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37Proportional Hazards Models
38RENAL-DISEASE
39RISK-FACTOR
40SERUM CREATININE
41Studies
42Systematic review
43Urinary system involvement in other diseases. Miscellaneous
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abstractSummary 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 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2 , adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05–1·32) for eGFR 60 mL/min/1·73 m2 , 1·57 (1·39–1·78) for 45 mL/min/1·73 m2 , and 3·14 (2·39–4·13) for 15 mL/min/1·73 m2 . 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 m2 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.
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