03720nas a2200445 4500008004100000022001400041245015900055210006900214260001600283520232600299100002102625700002102646700002102667700001802688700002102706700002102727700002302748700002602771700002102797700002102818700002402839700001702863700002402880700002302904700002102927700002402948700002302972700002702995700002103022700002003043700002403063700001703087700002503104700002103129700002203150700001903172700001803191710002903209856003603238 2018 eng d a1523-683800aRelationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium.0 aRelationship of Estimated GFR and Albuminuria to Concurrent Labo c2018 Oct 193 a

RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework.

STUDY DESIGN: Cross-sectional individual participant-level analyses in a global consortium.

SETTING & STUDY POPULATIONS: 17 CKD and 38 general population and high-risk cohorts.

SELECTION CRITERIA FOR STUDIES: Cohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension.

DATA EXTRACTION: Data were obtained and analyzed between July 2015 and January 2018.

ANALYTICAL APPROACH: We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses.

RESULTS: The CKD cohorts (n=254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n=1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years. There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 [95% CI, 2.68-3.97] to 8.91 [95% CI, 7.22-10.99] comparing eGFRs of 15 to 29 with eGFRs of 45 to 59mL/min/1.73m), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 [95% CI, 0.60-0.99] to 1.92 [95% CI, 1.65-2.24] comparing urinary albumin-creatinine ratio > 300 vs < 30mg/g).

LIMITATIONS: Variations in study era, health care delivery system, typical diet, and laboratory assays.

CONCLUSIONS: Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.

1 aInker, Lesley, A1 aGrams, Morgan, E1 aLevey, Andrew, S1 aCoresh, Josef1 aCirillo, Massimo1 aCollins, John, F1 aGansevoort, Ron, T1 aGutierrez, Orlando, M1 aHamano, Takayuki1 aHeine, Gunnar, H1 aIshikawa, Shizukiyo1 aJee, Sun, Ha1 aKronenberg, Florian1 aLandray, Martin, J1 aMiura, Katsuyuki1 aNadkarni, Girish, N1 aPeralta, Carmen, A1 aRothenbacher, Dietrich1 aSchaeffner, Elke1 aSedaghat, Sanaz1 aShlipak, Michael, G1 aZhang, Luxia1 avan Zuilen, Arjan, D1 aHallan, Stein, I1 aKovesdy, Csaba, P1 aWoodward, Mark1 aLevin, Adeera1 aCKD Prognosis Consortium uhttps://chs-nhlbi.org/node/7915