• Marije van der Velde, Kunihiro Matsushita, Josef Coresh, Brad C Astor, Mark Woodward, Andrew Levey, Paul de Jong, Ron T Gansevoort, Chronic Kidney Disease Prognosis Consortium, Andrew S Levey, Paul E de Jong, Meguid El-Nahas, Kai-Uwe Eckardt, Bertram L Kasiske, Toshiharu Ninomiya, John Chalmers, Stephen Macmahon, Marcello Tonelli, Brenda Hemmelgarn, Frank Sacks, Gary Curhan, Allan J Collins, Suying Li, Shu-Cheng Chen, K P Hawaii Cohort, Brian J Lee, Areef Ishani, James Neaton, Ken Svendsen, Johannes F E Mann, Salim Yusuf, Koon K Teo, Peggy Gao, Robert G Nelson, William C Knowler, Henk J Bilo, Hanneke Joosten, Nanno Kleefstra, K H Groenier, Priscilla Auguste, Kasper Veldhuis, Yaping Wang, Laura Camarata, Beverly Thomas, and Tom Manley.
• Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
• Kidney Int. 2011 Jun 1;79(12):1341-52.

AbstractScreening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m², but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m² were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.

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