Kidney international
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Kidney international · Jun 2011
Meta AnalysisLower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts.
Screening 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. ⋯ 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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Kidney international · Jun 2011
The severity of acute kidney injury predicts progression to chronic kidney disease.
Acute kidney injury (AKI) is associated with progression to advanced chronic kidney disease (CKD). We tested whether patients who survive AKI and are at higher risk for CKD progression can be identified during their hospital admission, thus providing opportunities to intervene. This was assessed in patients in the Department of Veterans Affairs Healthcare System hospitalized with a primary diagnosis indicating AKI (ICD9 codes 584.xx). ⋯ In model validation, all three were highly significant when tested in the confirmatory patients, with moderate to large effect sizes and good predictive accuracy ('c' 0.81-0.82). Patients with AKI who required dialysis and then recovered were at especially high risk for progression to CKD. Hence, the severity of AKI is a robust predictor of progression to CKD.
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Kidney international · Jun 2011
CommentStrengths and weaknesses of renal markers as risk factors and surrogate markers.
The reports of associations between albuminuria and estimated glomerular filtration rate and mortality are a major advance in understanding the progression of renal disease and its sequelae. These findings reinforce the importance of population risk profiling. However, application is limited by validity concerns due to substantial unexplained heterogeneity in many meta-analyses. Application to treatment decisions is premature given insufficient analysis of randomized trials of the association of by-arm differences in laboratory measures and by-arm differences in patient-relevant outcomes.
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Kidney international · May 2011
ReviewA mission in evolution: the International Society of Nephrology in the past 10 years--2001-2010.
The International Society of Nephrology is now 50 years old. It has dedicated the year 2010 to celebrate its Gold Anniversary in many ways, including documentation of its progress during the past decade, following an earlier article addressing the period 1960-2000. The present article describes the changing mission of the Society in the direction of achieving its ultimate vision of "global elimination of kidney disease." While maintaining its leadership in the promotion of science, it became the prime driving force in capacity building for the diagnosis, prevention and management of kidney disease in the developing world. ⋯ This required the acquisition of new skills in publishing, marketing, politics and fund-raising, which could only be handled by professional management, which the Society has utilized since 2003. It also necessitated enlargement of the leadership circle to include members from all over the world, for which reason the constitution had to be amended twice during the past decade, and the bylaws re-written in 2007. The pride that International Society of Nephrology takes from its scientific and outreach achievements is the fuel that drives its machinery to endless horizons in the humanitarian arena.