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Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.

TitleAssociations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.
Publication TypeJournal Article
Year of Publication2012
AuthorsFox, CS, Matsushita, K, Woodward, M, Bilo, HJG, Chalmers, J, Heerspink, HJLambers, Lee, BJ, Perkins, RM, Rossing, P, Sairenchi, T, Tonelli, M, Vassalotti, JA, Yamagishi, K, Coresh, J, de Jong, PE, Wen, C-P, Nelson, RG
Corporate/Institutional AuthorsChronic Kidney Disease Prognosis Consortium,
JournalLancet
Volume380
Issue9854
Pagination1662-73
Date Published2012 Nov 10
ISSN1474-547X
KeywordsAged, Albuminuria, Cardiovascular Diseases, Cause of Death, Diabetic Nephropathies, Female, Glomerular Filtration Rate, Humans, Kidney Failure, Chronic, Male, Middle Aged, Risk Factors
Abstract<p><b>BACKGROUND: </b>Chronic kidney disease is characterised by low estimated glomerular filtration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modified by diabetes is unknown.</p><p><b>METHODS: </b>We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and end-stage renal disease (ESRD) associated with eGFR and albuminuria in individuals with and without diabetes.</p><p><b>FINDINGS: </b>We analysed data for 1,024,977 participants (128,505 with diabetes) from 30 general population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and high-risk cohorts with data for all-cause mortality, 75,306 deaths occurred during a mean follow-up of 8·5 years (SD 5·0). In the 23 studies with data for cardiovascular mortality, 21,237 deaths occurred from cardiovascular disease during a mean follow-up of 9·2 years (SD 4·9). In the general and high-risk cohorts, mortality risks were 1·2-1·9 times higher for participants with diabetes than for those without diabetes across the ranges of eGFR and albumin-to-creatinine ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes groups, HR of mortality outcomes according to lower eGFR and higher ACR were much the same in participants with and without diabetes (eg, for all-cause mortality at eGFR 45 mL/min per 1·73 m(2) [vs 95 mL/min per 1·73 m(2)], HR 1·35; 95% CI 1·18-1·55; vs 1·33; 1·19-1·48 and at ACR 30 mg/g [vs 5 mg/g], 1·50; 1·35-1·65 vs 1·52; 1·38-1·67). The overall interactions were not significant. We identified much the same findings for ESRD in the chronic kidney disease cohorts.</p><p><b>INTERPRETATION: </b>Despite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes.</p><p><b>FUNDING: </b>US National Kidney Foundation.</p>
DOI10.1016/S0140-6736(12)61350-6
Alternate JournalLancet
PubMed ID23013602
PubMed Central IDPMC3771350
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
K23 DK067303 / DK / NIDDK NIH HHS / United States
N01 HC085086 / HC / NHLBI NIH HHS / United States
U01 DK035073 / DK / NIDDK NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
R01 AG015928 / AG / NIA NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
N01 HC075150 / HC / NHLBI NIH HHS / United States
K23 DK002904 / DK / NIDDK NIH HHS / United States
U10 EY006594 / EY / NEI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
N01 HC015103 / HC / NHLBI NIH HHS / United States
N01 HC025195 / HC / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
N01HC55222 / HL / NHLBI NIH HHS / United States
R01 AG007181 / AG / NIA NIH HHS / United States
R01 DK073217 / DK / NIDDK NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201200036C / HL / NHLBI NIH HHS / United States
R01 DK031801 / DK / NIDDK NIH HHS / United States
N01 HC055222 / HC / NHLBI NIH HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States
N01 HC095169 / HC / NHLBI NIH HHS / United States
R01 HL080295 / HL / NHLBI NIH HHS / United States
R01 AG020098 / AG / NIA NIH HHS / United States
N01HC75150 / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
N01 HC085079 / HC / NHLBI NIH HHS / United States
R01 HL068140 / HL / NHLBI NIH HHS / United States
R01 AG023629 / AG / NIA NIH HHS / United States
R01 AG028507 / AG / NIA NIH HHS / United States
R01 AG027058 / AG / NIA NIH HHS / United States
N01 HC045133 / HC / NHLBI NIH HHS / United States
N01 HC035129 / HC / NHLBI NIH HHS / United States
CZH/4/656 / / Chief Scientist Office / United Kingdom
R01 HL043232-03 / HL / NHLBI NIH HHS / United States
N01 HC095159 / HC / NHLBI NIH HHS / United States