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Kidney Int Rep. 2018 Jan 11;3(3):625-637. doi: 10.1016/j.ekir.2018.01.002. eCollection 2018 May.

Risk Factors for Prognosis in Patients With Severely Decreased GFR.

Author information

1
Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
2
Swedish Renal Registry, Jönköping, Sweden.
3
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
4
Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
5
Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands.
6
Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK.
7
Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.
8
Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
9
Salford Royal NHS Foundation Trust, Manchester, UK.
10
University of Tennessee Health Science Center, Memphis, Tennessee, USA.
11
Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA.
12
BC Provincial Renal Agency, Vancouver, British Columbia, Canada.
13
University of British Columbia, Vancouver, British Columbia, Canada.
14
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK.
15
Service de Néphrologie-Dialyses-Aphérèse, Hôpital Caremeau, CHU Nimes, France.
16
EA2415, Université Montpellier-Nimes, Nimes, France.
17
Department of Internal Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, Michigan, USA.
18
National Renal Health Care Program, Montevideo, Uruguay.
19
Department of Nephrology and Hypertension, University Hospital of the Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
20
Medical Division, Maccabi Healthcare Services, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
21
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
22
Division of Nephrology, Geisinger Health System, Danville, Pennsylvania, USA.
23
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
24
Peking University First Hospital, Beijing, China.
25
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.
26
Cumming School of Medicine, Division of Nephrology, Department of Community Health Sciences, University of Calgary, Alberta, Canada.
27
Centre for Nephrology, University College London, London, UK.

Abstract

Introduction:

Patients with chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m2 (corresponding to CKD stage G4+) comprise a minority of the overall CKD population but have the highest risk for adverse outcomes. Many CKD G4+ patients are older with multiple comorbidities, which may distort associations between risk factors and clinical outcomes.

Methods:

We undertook a meta-analysis of risk factors for kidney failure treated with kidney replacement therapy (KRT), cardiovascular disease (CVD) events, and death in participants with CKD G4+ from 28 cohorts (n = 185,024) across the world who were part of the CKD Prognosis Consortium.

Results:

In the fully adjusted meta-analysis, risk factors associated with KRT were time-varying CVD, male sex, black race, diabetes, lower eGFR, and higher albuminuria and systolic blood pressure. Age was associated with a lower risk of KRT (adjusted hazard ratio: 0.74; 95% confidence interval: 0.69-0.80) overall, and also in the subgroup of individuals younger than 65 years. The risk factors for CVD events included male sex, history of CVD, diabetes, lower eGFR, higher albuminuria, and the onset of KRT. Systolic blood pressure showed a U-shaped association with CVD events. Risk factors for mortality were similar to those for CVD events but also included smoking. Most risk factors had qualitatively consistent associations across cohorts.

Conclusion:

Traditional CVD risk factors are of prognostic value in individuals with an eGFR <30 ml/min per 1.73 m2, although the risk estimates vary for kidney and CVD outcomes. These results should encourage interventional studies on correcting risk factors in this high-risk population.

KEYWORDS:

chronic kidney disease; risk factors

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