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BMJ. 2013 Jan 29;346:f324. doi: 10.1136/bmj.f324.

Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis.

Collaborators (180)

Wright J, Appel L, Greene T, Astor BC, Chalmers J, MacMahon S, Woodward M, Arima H, Yatsuya H, Yamashita K, Toyoshima H, Tamakoshi K, Tonelli M, Hemmelgarn B, Bello A, James M, Coresh J, Astor BC, Matsushita K, Atkins RC, Polkinghorne KR, Chadban S, Dam B, 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 J, 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, Hawaii KP, 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, Iseki K, Nelson RG, Knowler WC, Gansevoort RT, de Jong PE, Mahmoodi BK, Hillege H, Bernardo R, Jassal SK, Barrett-Connor E, Bergstrom J, Heerspink HJ, Brenner BE, de Zeeuw D, Warnock DG, Muntner P, Judd S, McClellan W, Jee SH, Kimm H, Jo J, Mok Y, Choi E, 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 BR, 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

Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.



To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease.


Random effects meta-analysis using pooled individual participant data.


46 cohorts from Europe, North and South America, Asia, and Australasia.


2,051,158 participants (54% women) from general population cohorts (n=1,861,052), high risk cohorts (n=151,494), and chronic kidney disease cohorts (n=38,612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥ 50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (mg/g).


Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (P(interaction)<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (P(interaction)<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk.


Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.

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