Year: 2023
Type: review
Abstract: Importance: Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. Objective: To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. Design, Setting, and Participants: Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. Exposures: The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). Main Outcomes and Measures: The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. Results: Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]). Conclusions and Relevance: In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.
Source: JAMA
Authors: Lawrence J Appel, Morgan Grams, Mark Woodward, Katie Harris, Hisatomi Arima, John Chalmers, Hiroshi Yatsuya, Koji Tamakoshi, Yuanying Li, Josef Coresh, Yingying Sang, Kunihiro Matsushita, Kevan Polkinghorne, Steve Chadban, Adeera Levin, Ognjenka Djurdjev, Mila Tang, Luxia Zhang, Fang Wang, Jinwei Wang, Ming-Hui Zhao, Elke Schaeffner, Natalie Ebert, Nina Mielke, Marcello Tonelli, Anita Lloyd, Frank Sacks, Michael G Shlipak, Nisha Bansal, Mark Sarnak, Kazumasa Yamagishi, Isao Muraki, Yuji Shimizu, Hiroyasu Iso, Masafumi Fukagawa, Shoichi Maruyama, Takayuki Hamano, Naohiko Fujii, Takahiro Imaizumi, Natalia Alencar De Pinho, Marie Metzger, Bénédicte Stengel, Aghilès Hamroun, Ziad Massy, Tazeen H Jafar, Imtiaz Jehan, Juanita Hatcher, Nish Chaturvedi, Neil Poulter, David C Wheeler, Martin Landray, Amanda Anderson, Jing Chen, James Lash, Jon Taliercio, Peter (Wei) Yang, Katherine Tuttle, Radica Alicic, Susanne Nicholas, Jenny Shen, Ben Schöttker, Hannah Stocker, Dietrich Rothenbacher, Hermann Brenner, Daniel Levy, Shih-Jen Hwang, Markus P Schneider, Anna Köttgen, Heike Meiselbach, Kai-Uwe Eckardt, Alexander R Chang, Jamie A Green, H Lester Kirchner, Gurmukteshwar Singh, Simon Sawhney, Corri Black, Katie Wilde, Angharad Marks, Samira Bell, Moneeza Siddiqui, Colin Palmer, Ewan Pearson, Mariko Miyazaki, Masaaki Nakayama, Tae Yamamoto, Gen Yamada, Sadayoshi Ito, Massimo Cirillo, Angela Yee-Moon Wang, Henry Hon-Lin Wu, Hoi Ching Cheung, Victoria Ngai, Tang Ka Tak, Amit X Garg, Eric McArthur, Ann Young, Vivekanand Jha, Ashok Kumar Yadav, Vivek Kumar, April P Carson, Bessie A Young, Clarissa Diamantidis, Yuan-I Min, Tanjala S Purnell, Shizukiyo Ishikawa, Makiko Mieno, Kunihiro Yamagata, Kunitoshi Iseki, Koichi Asahi, Tsuneo Konta, Brian J Lee, Nigel J Brunskill, Laura Gray, Rupert Major, James Medcalf, Gabriel Chodick, Cheli Melzer Cohen, Jack FM Wetzels, Peter J Blankestijn, Arjan D van Zuilen, Lesley A Inker, Andrew S Levey, Joachim Ix, Ian de Boer, Ronit Katz, Florian Kronenberg, Barbara Kollerits, Eberhard Ritz, Dorothea Nitsch, Girish N Nadkarni, Lili Chan, Erwin P Bottinger, Wonsuk Oh, Zhihong Liu, Haitao Zhang, Lihua Zhang, Jose M Valdivielso, Marcelino Bermudez-Lopez, Milica Bozic, Maite Caus, Juan Miguel Diaz-Tocados, Benedicte Stengel, Katsuyuki Miura, Hirotsugu Ueshima, Akira Okayama, Aya Kadota, Tomonori Okamura, Laura Sola, Alejandro Ferreiro, Jose Santiago, Pablo Rios, Liliana Gadola, Ricardo Silvariño, Takayoshi Ohkubo, Michihiro Satoh, Hirohito Metoki, Masahiro Kikuya, Elizabeth Ciemins, Jeff Mohl, Robert G Nelson, Robert L Hanson, Helen C Looker, Ron T Gansevoort, Lyanne M Kieneker, Stephan JL Bakker, Olivier Moranne, Cecile Couchoud, David Shepherd, Simerjot K Jassal, Jaclyn Bergstrom, Csaba P Kovesdy, Keiichi Sumida, Prabin Shrestha, Orlando Gutierrez, Katharine Cheung, Paul Muntner, Titi Ilori, Michelle Pena, Hiddo JL Heerspink, Edouard L Fu, Carl-Gustaf Elinder, Peter Barany, Juan J Carrero, Marie Evans, Charumathi Sabanayagam, Ching-Yu Cheng, Tien Yin Wong, Crystal Chong Chun Yuen, William Herrington, Natalie Staplin, Martin J Landray, Colin Baigent, Philip Kalra, Rajkumar Chinnadurai, Darren Green, Smeeta Sinha, James Ritchie, Frank LJ Visseren, Pascal Burger, Marielle Emmelot, Berend van Welzen, Oommen John, Balaji Gummidi, Arpita Ghosh, David Naimark, Navdeep Tangri, Chi-Pang Wen, Min-Kuang Tsai, Yoshiyuki Ueno, Masafumi Watanabe, Kazunobu Ichikawa, Mohammadhassan Mirbolouk, Fereidoun Azizi, Farzad Hadaegh, Farhad Hosseinpanah, Wen Shi, Dan Arking, Johan Ärnlöv, Anders Larsson, Vilmantas Giedraitis, Patrick Mark, Jamie Traynor, Michael Sullivan, Jennifer Lees, Jae won Yang, Jae il Shin, Jun young Lee, Jae seok Kim, Henk JG Bilo, Peter van Dijk, Mireille Edens, Joep Dille, Shoshana H Ballew, Juan-Jesus Carrero, Morgan E Grams, Jingsha Chen, Aditya Surapaneni, Morgan E. Grams, Josef Coresh, Kunihiro Matsushita, Shoshana H. Ballew, Yingying Sang, Aditya Surapaneni, Natalia Alencar de Pinho, Amanda Anderson, Lawrence J. Appel, Johan Ärnlöv, Fereidoun Azizi, Nisha Bansal, Samira Bell, Henk J. G. Bilo, Nigel J. Brunskill, Juan J. Carrero, Steve Chadban, John Chalmers, Jing Chen, Elizabeth Ciemins, Massimo Cirillo, Natalie Ebert, Marie Evans, Alejandro Ferreiro, Edouard L. Fu, Masafumi Fukagawa, Jamie A. Green, Orlando M. Gutierrez, William G. Herrington, Shih-Jen Hwang, Lesley A. Inker, Kunitoshi Iseki, Tazeen Jafar, Simerjot K. Jassal, Vivekanand Jha, Aya Kadota, Ronit Katz, Anna Köttgen, Tsuneo Konta, Florian Kronenberg, Brian J. Lee, Jennifer Lees, Adeera Levin, Helen C. Looker, Rupert Major, Cheli Melzer Cohen, Makiko Mieno, Mariko Miyazaki, Olivier Moranne, Isao Muraki, David Naimark, Dorothea Nitsch, Wonsuk Oh, Michelle Pena, Tanjala S. Purnell, Charumathi Sabanayagam, Michihiro Satoh, Simon Sawhney, Elke Schaeffner, Ben Schöttker, Jenny I. Shen, Michael G. Shlipak, Smeeta Sinha, Benedicte Stengel, Keiichi Sumida, Marcello Tonelli, Jose M. Valdivielso, Arjan D. van Zuilen, Frank L. J. Visseren, Angela Yee-Moon Wang, Chi-Pang Wen, David C. Wheeler, Hiroshi Yatsuya, Kunihiro Yamagata, Jae won Yang, Ann Young, Haitao Zhang, Luxia Zhang, Andrew S. Levey, Ron T. Gansevoort
Institutions: Johns Hopkins University, New York University, Manipal Academy of Higher Education, UNSW Sydney, The George Institute for Global Health, Imperial College London, Nagoya University, Royal Prince Alfred Hospital, University of British Columbia, Peking University First Hospital, Charité – Universitätsmedizin Berlin, University of Calgary, San Francisco VA Medical Center, University of California, San Francisco, San Francisco VA Health Care System, University of Washington, The University of Osaka, Tokai University, Inserm, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Centre de recherche en Epidémiologie et Santé des Populations, Duke University, Duke-NUS Medical School, University College London, Tulane University, University of California, Los Angeles, Harbor–UCLA Medical Center, German Cancer Research Center, National Heart, Lung, and Blood Institute, Framingham Heart Study, National Heart, Lung, and Blood Institute Division of Intramural Research, University of Freiburg, Geisinger Medical Center, Geisinger Health System, Geisinger College of Health Sciences, University of Aberdeen, NHS Grampian, University of Dundee, Tohoku University, University of Salerno, Queen Mary Hospital, University of Hong Kong, University of Toronto, Unity Health Toronto, The George Institute for Global Health, George Institute for Global Health, Jichi Medical University, University of Tsukuba, Yamagata University, Kaiser Permanente, Kaiser Permanente Moanalua Medical Center, University of Leicester, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Maccabi Healthcare Services, University Medical Center Utrecht, Tufts Medical Center, Innsbruck Medical University, Universität Innsbruck, London School of Hygiene & Tropical Medicine, Icahn School of Medicine at Mount Sinai, Nanjing General Hospital of Nanjing Military Command, Nanjing University, Universitat de Lleida, Instituto de Investigación Biomédica de Lleida, Shiga University of Medical Science, Universidad de la República de Uruguay, Tohoku Medical and Pharmaceutical University, American Medical Group Association, National Institute of Diabetes and Digestive and Kidney Diseases, University Medical Center Groningen, University of Groningen, Université de Montpellier, Centre Hospitalier Universitaire de Nîmes, University of California San Diego, VA San Diego Healthcare System, University of Tennessee Health Science Center, University of Alabama at Birmingham, Brigham and Women's Hospital, Harvard University, Danderyds sjukhus, Karolinska Institutet, Karolinska University Hospital, Singapore National Eye Center, Singapore Eye Research Institute, University of Oxford, MRC Population Health Research Unit, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Utrecht University, National Health Research Institutes, China Medical University Hospital, Research Institute for Endocrine Sciences, Shahid Beheshti University, Shahid Beheshti University of Medical Sciences, Dalarna University, Queen Elizabeth University Hospital, University of Glasgow, Yonsei University
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funders: Amgen, Eli Lilly and Company, AstraZeneca, GlaxoSmithKline, Sanofi, Brigham and Women's Hospital, Kaiser Permanente, University of Pennsylvania, Tufts Medical Center, MSD France, University of Washington, Tulane University, Johns Hopkins University, Deutsches Krebsforschungszentrum, University of Dundee, Wellcome Trust, University Hospitals of Leicester NHS Trust, Duke-NUS Medical School, Georgia Clinical and Translational Science Alliance, Geisinger Commonwealth School of Medicine, York University, National Institute for Health and Care Research, British Heart Foundation, Kidney Research UK, Diabetes UK, British Renal Society, Academy of Medical Sciences, University of Leicester, Imperial College London, University of Oxford, Deutsche Forschungsgemeinschaft, Institut National de la Santé et de la Recherche Médicale, Rijksuniversiteit Groningen, University of New South Wales, Bundesministerium für Bildung und Forschung, Albert-Ludwigs-Universität Freiburg, Karolinska Institutet, Universitair Medisch Centrum Groningen, Högskolan Dalarna, Shahid Beheshti University of Medical Sciences, Universidad de la República Uruguay, Università degli Studi di Salerno, Otsuka Pharmaceutical, Boehringer Ingelheim France, National Institutes of Health, Centers for Disease Control and Prevention, University of Illinois at Urbana-Champaign, School of Medicine, New York University, Duke Global Health Institute, Duke University, University of California, Los Angeles, Perelman School of Medicine, University of Pennsylvania, University of California, San Francisco, Michigan Institute for Clinical and Health Research, Johns Hopkins Bloomberg School of Public Health, Clinical and Translational Science Collaborative of Cleveland, School of Medicine, Case Western Reserve University, Medical Research Council, National Health and Medical Research Council, Japan Society for the Promotion of Science, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, School of Medicine, Tokai University, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, National Center for Advancing Translational Sciences, NHLBI Division of Intramural Research
Awards: G1022778538, G1251546689, Clinical and Translational Science Institute, G1743780862, American Indian Chronic Renal Insufficiency Cohort Study (AI-CRIC), G198381471, G19956286, Adiposity and kidney disease: observations from large blood-based prospective cohorts across a wide range of different populations, G250621538, Continuation of the Chronic Renal Insufficiency Cohort (CRIC) Study, G3042145041, G3340927746, General Clinical Research Center, G3719111573, G37449730, G3779191537, SFB 1453: Nephrogenetik (NephGen), Big Omics Data Engine 2 Supercomputer, G4397854981, Elucidation of the regulatory mechanisms of urinary microRNA expression and its clinical implementation as a biomarker for renal disease, G5314081182, Verbundprojekt: Beobachtungsstudie zur chronischen Niereninsuffizienz in Deutschland (GCKD) Studie - TP2 Regionalzentren (anteilig), G561423854, Center for Clinical and Translational Science, Randomised trials in cardiovascular and metabolic disease, G5916773000, Verbundprojekt: Beobachtungsstudie zur chronischen Niereninsuffizienz in Deutschland (GCKD-Studie) - TP1 Studienzentrale, TP2 Regionalzentren (anteilig) und TP4 Substudie Koronarkalzifizierung (anteilig), Verbundprojekt: Beobachtungsstudie zur chronischen Niereninsuffizienz in Deutschland (GCKD-Studie) - TP2 Regionalzentren (anteilig) und TP4 Substudie Koronarkalzifizierung (anteilig), G642672552, Worsening of chronic condition during COVID-19 pandemic and association of occupational factors with the incidence of cardiovascular diseases in workers with chronic condition, Michigan Institute for Clinical and Health Research (MCHR), Verbundprojekt: Beobachtungsstudie zur chronischen Niereninsuffizienz in Deutschland (GCKD Studie) - TP3 Proteomanalytik, G7099572599, G7308200478, Institute for Clinical and Translational Research, Institutional Clinical and Translational Science Award, G7958222963, COVID and Translational Science supercomputer (CATS), G8287218166, Clinical and Translational Science Collaborative of Cleveland, Verbundprojekt: Beobachtungsstudie zur chronischen Niereninsuffizienz in Deutschland (GCKD Studie) - TP2 Regionalzentren (anteilig), G8534382735, G8660623442, G8676708184, G8769141367, G8960721469, G9000124674, Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases, Prospective renal insufficiency cohort evaluation: PRICE, Chronic Renal Insufficiency Cohort (CRIC) Study Clinical Center, Chronic Kidney Disease Prognosis Consortium (CKD-PC), Continuation of the Chronic Renal Insufficiency Cohort (CRIC), Continuation of the University of Illinois Chicago CRIC Clinical Center, Limited Competition for the Continuation of the Chronic Renal Insufficiency Cohort (CRIC) Hopkins Clinical Center, Tulane Clinical Center for Chronic Renal Insufficiency Cohort Study, Chronic Renal Insufficiency Cohort Limited competition continuation, Chronic Renal Insufficiency Cohort (CRIC) Study, UAB Diabetes Research Center
OpenAlex ID: W4387296715