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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.
Tuesday,2013-10-01 10:11 America/Los_Angeles — poolea2
| Title | Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. |
| Publication Type | Journal Article |
| Year of Publication | 2012 |
| Authors | Fox, 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 Authors | Chronic Kidney Disease Prognosis Consortium, |
| Journal | Lancet |
| Volume | 380 |
| Issue | 9854 |
| Pagination | 1662-73 |
| Date Published | 2012 Nov 10 |
| ISSN | 1474-547X |
| Keywords | Aged, 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> |
| DOI | 10.1016/S0140-6736(12)61350-6 |
| Alternate Journal | Lancet |
| PubMed ID | 23013602 |
| PubMed Central ID | PMC3771350 |
| 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 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 |