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Age and association of kidney measures with mortality and end-stage renal disease.
Thursday,2017-05-11 16:21 America/Los_Angeles — ecterry
| Title | Age and association of kidney measures with mortality and end-stage renal disease. |
| Publication Type | Journal Article |
| Year of Publication | 2012 |
| Authors | Hallan, SI, Matsushita, K, Sang, Y, Mahmoodi, BK, Black, C, Ishani, A, Kleefstra, N, Naimark, D, Roderick, P, Tonelli, M, Wetzels, JFM, Astor, BC, Gansevoort, RT, Levin, A, Wen, C-P, Coresh, J |
| Corporate/Institutional Authors | Chronic Kidney Disease Prognosis Consortium, |
| Journal | JAMA |
| Volume | 308 |
| Issue | 22 |
| Pagination | 2349-60 |
| Date Published | 2012 Dec 12 |
| ISSN | 1538-3598 |
| Keywords | Adolescent, Adult, Age Factors, Aged, Albuminuria, Cohort Studies, Female, Glomerular Filtration Rate, Humans, Kidney, Kidney Failure, Chronic, Male, Middle Aged, Risk, Young Adult |
| Abstract | <p><b>CONTEXT: </b>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.</p><p><b>OBJECTIVE: </b>To evaluate possible effect modification (interaction) by age of the association of eGFR and albuminuria with clinical risk, examining both relative and absolute risks.</p><p><b>DESIGN, SETTING, AND PARTICIPANTS: </b>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).</p><p><b>MAIN OUTCOME MEASURES: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.1001/jama.2012.16817 |
| Alternate Journal | JAMA |
| PubMed ID | 23111824 |
| PubMed Central ID | PMC3936348 |
| Grant List | HHSN268201100012C / 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 U01 NS041588 / NS / NINDS NIH HHS / United States UL1 TR000439 / TR / NCATS 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 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 |
ePub date:
12/12