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Lancet. 2012 Nov 10;380(9854):1662-73. doi: 10.1016/S0140-6736(12)61350-6. Epub 2012 Sep 24.

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

Collaborators (173)

Wright J, Appel L, Greene T, Astor BC, Chalmers J, MacMahon S, Woodward M, Arima H, Yatsuya H, Yamashita K, Toyoshima H, Tamakoshi K, Coresh J, Astor BC, Matsushita K, Sang Y, Atkins RC, Polkinghorne KR, Chadban S, Shankar A, Klein R, Klein BE, Lee KE, Wang H, Wang F, Zhang L, Zuo L, Levin A, Djurdjev O, Tonelli M, Sacks FM, Curhan GC, Shlipak M, Peralta C, Katz R, Fried L, Iso H, Kitamura A, Ohira T, Yamagishi K, Jafar TH, Islam M, Hatcher J, Poulter N, Chaturvedi N, Landray MJ, Emberson JR, Townend JN, Wheeler DC, Rothenbacher D, Brenner H, Müller H, Schöttker B, Fox CS, Hwang SJ, Meigs JB, Perkins RM, Fluck N, Clark LE, Prescott GJ, Marks A, Black C, Cirillo M, Hallan S, Aasarød K, Øien CM, Radtke M, Irie F, Iso H, Sairenchi T, Yamagishi K, Smith DH, Weiss JW, Johnson ES, Thorp ML, Collins AJ, Vassalotti JA, Li S, Chen SC, Lee BJ, Wetzels JF, Blankestijn PJ, van Zuilen AD, Sarnak M, Levey AS, Menon V, Shlipak M, Sarnak M, Peralta C, Katz R, Kramer HJ, de Boer IH, Kronenberg F, Kollerits B, Ritz E, Roderick P, Nitsch D, Fletcher A, Bulpitt C, Ishani A, Neaton JD, Froissart M, Stengel B, Metzger M, Haymann JP, Houillier P, Flamant M, Astor BC, Coresh J, Matsushita K, Ohkubo T, Metoki H, Nakayama M, Kikuya M, Imai Y, Nelson RG, Knowler WC, Gansevoort RT, de Jong PE, Mahmoodi BK, Bakker SJ, Jassal SK, Barrett-Connor E, Bergstrom J, Lambers Heerspink HJ, Brenner BE, de Zeeuw D, Warnock DG, Muntner P, Judd S, McClellan W, Jee SH, Kimm H, Jo J, Mok Y, Lim JE, Rossing P, Parving HH, Tangri N, Naimark D, Wen CP, Wen SF, Tsao CK, Tsai MK, Ärnlöv J, Lannfelt L, Larsson A, Bilo HJ, Joosten H, Kleefstra N, Groenier KH, Drion I, Astor BC, Coresh J, Gansevoort RT, Hemmelgarn B, de Jong PE, Levey AS, Levin A, Matsushita K, Wen CP, Woodward M, Ballew SH, Coresh J, Grams M, Mahmoodi BK, Matsushita K, Sang Y, Woodward M, Camarata L, Hui X, Seltzer J, Winegrad H.

Author information

1
National Heart, Lung, and Blood Institute's Framingham Heart Study, Center for Population Studies Framingham, MA, USA.

Erratum in

  • Lancet. 2013 Feb 2;381(9864):374.

Abstract

BACKGROUND:

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.

METHODS:

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.

FINDINGS:

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.

INTERPRETATION:

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.

FUNDING:

US National Kidney Foundation.

PMID:
23013602
PMCID:
PMC3771350
DOI:
10.1016/S0140-6736(12)61350-6
[Indexed for MEDLINE]
Free PMC Article

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