• Brad C Astor, Kunihiro Matsushita, Ron T Gansevoort, Marije van der Velde, Mark Woodward, Andrew S Levey, Paul E de Jong, Josef Coresh, Chronic Kidney Disease Prognosis Consortium, Meguid El-Nahas, Kai-Uwe Eckardt, Bertram L Kasiske, Jackson Wright, Larry Appel, Tom Greene, Adeera Levin, Ognjenka Djurdjev, David C Wheeler, Martin J Landray, John N Townend, Jonathan Emberson, Laura E Clark, Alison Macleod, Angharad Marks, Tariq Ali, Nicholas Fluck, Gordon Prescott, David H Smith, Jessica R Weinstein, Eric S Johnson, Micah L Thorp, Jack F Wetzels, P J Blankestijn, A D van Zuilen, Vandana Menon, Mark Sarnak, Gerald Beck, Florian Kronenberg, Barbara Kollerits, Marc Froissart, Benedicte Stengel, Marie Metzger, Giuseppe Remuzzi, Piero Ruggenenti, Annalisa Perna, H J Lambers Heerspink, Barry Brenner, Dick de Zeeuw, Peter Rossing, Hans-Henrik Parving, Priscilla Auguste, Kasper Veldhuis, Yaping Wang, Laura Camarata, Beverly Thomas, and Tom Manley.
• Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
• Kidney Int. 2011 Jun 1;79(12):1331-40.

AbstractWe studied here the independent associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in individuals with chronic kidney disease (CKD). We performed a collaborative meta-analysis of 13 studies totaling 21,688 patients selected for CKD of diverse etiology. After adjustment for potential confounders and albuminuria, we found that a 15 ml/min per 1.73 m² lower eGFR below a threshold of 45 ml/min per 1.73 m² was significantly associated with mortality and ESRD (pooled hazard ratios (HRs) of 1.47 and 6.24, respectively). There was significant heterogeneity between studies for both HR estimates. After adjustment for risk factors and eGFR, an eightfold higher albumin- or protein-to-creatinine ratio was significantly associated with mortality (pooled HR 1.40) without evidence of significant heterogeneity and with ESRD (pooled HR 3.04), with significant heterogeneity between HR estimates. Lower eGFR and more severe albuminuria independently predict mortality and ESRD among individuals selected for CKD, with the associations stronger for ESRD than for mortality. Thus, these relationships are consistent with CKD stage classifications based on eGFR and suggest that albuminuria provides additional prognostic information among individuals with CKD.

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