04194nas a2200517 4500008004100000022001400041245008700055210006900142260001600211300001200227490000800239520279100247653001503038653001003053653001603063653000903079653001603088653001903104653001103123653003103134653001103165653001103176653002803187653000903215653001603224653000903240653001603249100002103265700002503286700001903311700002703330700001703357700001803374700002103392700001903413700001903432700002203451700002303473700001903496700002303515700001803538700001803556700001803574710004803592856003603640 2012 eng d a1538-359800aAge and association of kidney measures with mortality and end-stage renal disease.0 aAge and association of kidney measures with mortality and endsta c2012 Dec 12 a2349-600 v3083 a

CONTEXT: Chronic kidney disease (CKD) is prevalent in older individuals, but the risk implications of low estimated glomerular filtration rate (eGFR) and high albuminuria across the full age range are controversial.

OBJECTIVE: To evaluate possible effect modification (interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks.

DESIGN, SETTING, AND PARTICIPANTS: Individual-level meta-analysis including 2,051,244 participants from 33 general population or high-risk (of vascular disease) cohorts and 13 CKD cohorts from Asia, Australasia, Europe, and North/South America, conducted in 1972-2011 with a mean follow-up time of 5.8 years (range, 0-31 years).

MAIN OUTCOME MEASURES: Hazard ratios (HRs) of mortality and end-stage renal disease (ESRD) according to eGFR and albuminuria were meta-analyzed across age categories after adjusting for sex, race, cardiovascular disease, diabetes, systolic blood pressure, cholesterol, body mass index, and smoking. Absolute risks were estimated using HRs and average incidence rates.

RESULTS: Mortality (112,325 deaths) and ESRD (8411 events) risks were higher at lower eGFR and higher albuminuria in every age category. In general and high-risk cohorts, relative mortality risk for reduced eGFR decreased with increasing age; eg, adjusted HRs at an eGFR of 45 mL/min/1.73 m2 vs 80 mL/min/1.73 m2 were 3.50 (95% CI, 2.55-4.81), 2.21 (95% CI, 2.02-2.41), 1.59 (95% CI, 1.42-1.77), and 1.35 (95% CI, 1.23-1.48) in age categories 18-54, 55-64, 65-74, and ≥75 years, respectively (P <.05 for age interaction). Absolute risk differences for the same comparisons were higher at older age (9.0 [95% CI, 6.0-12.8], 12.2 [95% CI, 10.3-14.3], 13.3 [95% CI, 9.0-18.6], and 27.2 [95% CI, 13.5-45.5] excess deaths per 1000 person-years, respectively). For increased albuminuria, reduction of relative risk with increasing age was less evident, while differences in absolute risk were higher in older age categories (7.5 [95% CI, 4.3-11.9], 12.2 [95% CI, 7.9-17.6], 22.7 [95% CI, 15.3-31.6], and 34.3 [95% CI, 19.5-52.4] excess deaths per 1000 person-years, respectively by age category, at an albumin-creatinine ratio of 300 mg/g vs 10 mg/g). In CKD cohorts, adjusted relative hazards of mortality did not decrease with age. In all cohorts, ESRD relative risks and absolute risk differences at lower eGFR or higher albuminuria were comparable across age categories.

CONCLUSIONS: Both low eGFR and high albuminuria were independently associated with mortality and ESRD regardless of age across a wide range of populations. Mortality showed lower relative risk but higher absolute risk differences at older age.

10aAdolescent10aAdult10aAge Factors10aAged10aAlbuminuria10aCohort Studies10aFemale10aGlomerular Filtration Rate10aHumans10aKidney10aKidney Failure, Chronic10aMale10aMiddle Aged10aRisk10aYoung Adult1 aHallan, Stein, I1 aMatsushita, Kunihiro1 aSang, Yingying1 aMahmoodi, Bakhtawar, K1 aBlack, Corri1 aIshani, Areef1 aKleefstra, Nanne1 aNaimark, David1 aRoderick, Paul1 aTonelli, Marcello1 aWetzels, Jack, F M1 aAstor, Brad, C1 aGansevoort, Ron, T1 aLevin, Adeera1 aWen, Chi-Pang1 aCoresh, Josef1 aChronic Kidney Disease Prognosis Consortium uhttps://chs-nhlbi.org/node/738004730nas a2200541 4500008004100000022001400041245013100055210006900186260001600255300001200271490000800283520307700291653003903368653000903407653001503416653003703431653002803468653001903496653003203515653004003547653001103587653003103598653001103629653002803640653000903668653001603677653002403693653002003717653001603737100002503753700002703778700001903805700002603824700002103850700001703871700002703888700001903915700002003934700002203954700002203976700001803998700001804016700002304034700002604057700002104083710004804104856003604152 2012 eng d a1538-359800aComparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate.0 aComparison of risk prediction using the CKDEPI equation and the  c2012 May 09 a1941-510 v3073 a

CONTEXT: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk implications in diverse settings is lacking.

OBJECTIVE: To evaluate risk implications of estimated GFR using the CKD-EPI equation compared with the MDRD Study equation in populations with a broad range of demographic and clinical characteristics.

DESIGN, SETTING, AND PARTICIPANTS: A meta-analysis of data from 1.1 million adults (aged ≥ 18 years) from 25 general population cohorts, 7 high-risk cohorts (of vascular disease), and 13 CKD cohorts. Data transfer and analyses were conducted between March 2011 and March 2012.

MAIN OUTCOME MEASURES: All-cause mortality (84,482 deaths from 40 cohorts), cardiovascular mortality (22,176 events from 28 cohorts), and end-stage renal disease (ESRD) (7644 events from 21 cohorts) during 9.4 million person-years of follow-up; the median of mean follow-up time across cohorts was 7.4 years (interquartile range, 4.2-10.5 years).

RESULTS: Estimated GFR was classified into 6 categories (≥90, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73 m(2)) by both equations. Compared with the MDRD Study equation, 24.4% and 0.6% of participants from general population cohorts were reclassified to a higher and lower estimated GFR category, respectively, by the CKD-EPI equation, and the prevalence of CKD stages 3 to 5 (estimated GFR <60 mL/min/1.73 m(2)) was reduced from 8.7% to 6.3%. In estimated GFR of 45 to 59 mL/min/1.73 m(2) by the MDRD Study equation, 34.7% of participants were reclassified to estimated GFR of 60 to 89 mL/min/1.73 m(2) by the CKD-EPI equation and had lower incidence rates (per 1000 person-years) for the outcomes of interest (9.9 vs 34.5 for all-cause mortality, 2.7 vs 13.0 for cardiovascular mortality, and 0.5 vs 0.8 for ESRD) compared with those not reclassified. The corresponding adjusted hazard ratios were 0.80 (95% CI, 0.74-0.86) for all-cause mortality, 0.73 (95% CI, 0.65-0.82) for cardiovascular mortality, and 0.49 (95% CI, 0.27-0.88) for ESRD. Similar findings were observed in other estimated GFR categories by the MDRD Study equation. Net reclassification improvement based on estimated GFR categories was significantly positive for all outcomes (range, 0.06-0.13; all P < .001). Net reclassification improvement was similarly positive in most subgroups defined by age (<65 years and ≥65 years), sex, race/ethnicity (white, Asian, and black), and presence or absence of diabetes and hypertension. The results in the high-risk and CKD cohorts were largely consistent with the general population cohorts.

CONCLUSION: The CKD-EPI equation classified fewer individuals as having CKD and more accurately categorized the risk for mortality and ESRD than did the MDRD Study equation across a broad range of populations.

10aAfrican Continental Ancestry Group10aAged10aAlgorithms10aAsian Continental Ancestry Group10aCardiovascular Diseases10aCohort Studies10aDecision Support Techniques10aEuropean Continental Ancestry Group10aFemale10aGlomerular Filtration Rate10aHumans10aKidney Failure, Chronic10aMale10aMiddle Aged10aModels, Theoretical10aRisk Assessment10aSex Factors1 aMatsushita, Kunihiro1 aMahmoodi, Bakhtawar, K1 aWoodward, Mark1 aEmberson, Jonathan, R1 aJafar, Tazeen, H1 aJee, Sun, Ha1 aPolkinghorne, Kevan, R1 aShankar, Anoop1 aSmith, David, H1 aTonelli, Marcello1 aWarnock, David, G1 aWen, Chi-Pang1 aCoresh, Josef1 aGansevoort, Ron, T1 aHemmelgarn, Brenda, R1 aLevey, Andrew, S1 aChronic Kidney Disease Prognosis Consortium uhttps://chs-nhlbi.org/node/1385