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A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury.
Friday,2015-08-28 10:14 America/Los_Angeles — zdrager
| Title | A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury. |
| Publication Type | Journal Article |
| Year of Publication | 2015 |
| Authors | Grams, ME, Sang, Y, Ballew, SH, Gansevoort, RT, Kimm, H, Kovesdy, CP, Naimark, D, Oien, C, Smith, DH, Coresh, J, Sarnak, MJ, Stengel, B, Tonelli, M |
| Corporate/Institutional Authors | CKD Prognosis Consortium |
| Journal | Am J Kidney Dis |
| Volume | 66 |
| Issue | 4 |
| Pagination | 591-601 |
| Date Published | 2015 Oct |
| ISSN | 1523-6838 |
| Keywords | Acute Kidney Injury, Adolescent, Adult, African Americans, Age Distribution, Aged, Albuminuria, Continental Population Groups, European Continental Ancestry Group, Female, Glomerular Filtration Rate, Humans, Incidence, Male, Middle Aged, Predictive Value of Tests, Prognosis, Severity of Illness Index, Sex Distribution, Young Adult |
| Abstract | <p><b>BACKGROUND: </b>Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white).</p><p><b>STUDY DESIGN: </b>Collaborative meta-analysis.</p><p><b>SETTING & POPULATION: </b>8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants).</p><p><b>SELECTION CRITERIA FOR STUDIES: </b>Available eGFR, ACR, and 50 or more AKI events.</p><p><b>PREDICTORS: </b>Age, sex, race, eGFR, urine ACR, and interactions.</p><p><b>OUTCOME: </b>Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.</p><p><b>RESULTS: </b>16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR.</p><p><b>LIMITATIONS: </b>Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code.</p><p><b>CONCLUSIONS: </b>Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.</p> |
| DOI | 10.1053/j.ajkd.2015.02.337 |
| Alternate Journal | Am. J. Kidney Dis. |
| PubMed ID | 25943717 |
| PubMed Central ID | PMC4584180 |
| Grant List | HHSN268200800007C / HL / NHLBI NIH HHS / United States HHSN268201100005C / HL / NHLBI NIH HHS / United States HHSN268201100006C / HL / NHLBI NIH HHS / United States HHSN268201100007C / HL / NHLBI NIH HHS / United States HHSN268201100008C / HL / NHLBI NIH HHS / United States HHSN268201100009C / HL / NHLBI NIH HHS / United States HHSN268201100010C / HL / NHLBI NIH HHS / United States HHSN268201100011C / HL / NHLBI NIH HHS / United States HHSN268201100012C / HL / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States K08 DK092287 / DK / NIDDK NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01 DK096920 / DK / NIDDK NIH HHS / United States R01 DK100446 / DK / NIDDK NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States R01DK100446-01 / DK / NIDDK NIH HHS / United States UL1 TR001079 / TR / NCATS NIH HHS / United States |