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Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis
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2013 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, f324- p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: 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.

DESIGN: Random effects meta-analysis using pooled individual participant data.

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

PARTICIPANTS: 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).

RESULTS: 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.

CONCLUSIONS: 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.

Place, publisher, year, edition, pages
2013. Vol. 346, f324- p.
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Clinical Medicine
Identifiers
URN: urn:nbn:se:uu:diva-197363DOI: 10.1136/bmj.f324ISI: 000314510400003PubMedID: 23360717OAI: oai:DiVA.org:uu-197363DiVA: diva2:612766
Note

Co-author: Anders Larsson, Uppsala universitet, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion, ingår i the Chronic Kidney Disease Prognosis Consortium.

Available from: 2013-03-25 Created: 2013-03-25 Last updated: 2017-12-06Bibliographically approved

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