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Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes

医学 蛋白尿 肾功能 肌酐 肾脏疾病 胱抑素C 内科学 人口 泌尿科 环境卫生
作者
Lawrence J. Appel,Morgan E. Grams,Mark Woodward,Katie Harris,Hisatomi Arima,John Chalmers,Hiroshi Yatsuya,Koji Tamakoshi,Yuanying Li,Josef Coresh,Yingying Sang,Kunihiro Matsushita,Kevan Polkinghorne,Steven J. Chadban,Adeera Levin,Ognjenka Djurdjev,Mila Tang,Luxia Zhang,Fang Wang,Jinwei Wang,Ming‐Hui Zhao,Elke Schaeffner,Natalie Ebert,Nina Mielke,Marcello Tonelli,Anita Lloyd,Frank M. Sacks,Michael G. Shlipak,Nisha Bansal,Mark J. Sarnak,Kazumasa Yamagishi,Isao Muraki,Yūji Shimizu,Hiroyasu Iso,Masafumi Fukagawa,Shoichi Maruyama,Takayuki Hamano,Naohiko Fujii,Takahiro Imaizumi,Natália Alencar de Pinho,Marie Metzger,Bénédicte Stengel,Aghilès Hamroun,Ziad Massy,Tazeen H. Jafar,Imtiaz Jehan,Juanita Hatcher,Nish Chaturvedi,Neil Poulter,David C. Wheeler,Martin Landray,Amanda Anderson,Jing Chen,James Lash,Jon Taliercio,Peter Yang,Katherine R. Tuttle,Radica Alicic,Susanne B. Nicholas,Jenny I. Shen,Ben Schöttker,Hannah Stocker,Dietrich Rothenbacher,Hermann Brenner,Daniel Levy,Shih‐Jen Hwang,Markus P. Schneider,Anna Köttgen,Heike Meiselbach,Kai‐Uwe Eckardt,Alex R. Chang,Jamie A. Green,H. Lester Kirchner,Gurmukteshwar Singh,Simon Sawhney,Corri Black,Katie Wilde,Angharad Marks,Samira Bell,Moneeza K. Siddiqui,Nicholette D. Palmer,Ewan R. Pearson,Mariko Miyazaki,Masaaki Nakayama,Tae Yamamoto,Gen Yamada,Sadayoshi Ito,Massimo Círillo,Angela Yee‐Moon Wang,Henry H. L. Wu,Hoi Ching Cheung,Victoria Ngai,Tang Ka Tak,Amit X. Garg,Eric McArthur,Ann Young,Vivekanand Jha,Ashok Kumar Yadav,Vivek Kumar,April P. Carson,Bessie A Young,Clarissa Diamantidis,Yuan‐I Min,Tanjala S. Purnell,Shizukiyo Ishikawa,Makiko Mieno,Kunihiro Yamagata,Kunitoshi Iseki,Koichi Asahi,Tsuneo Konta,Brian J. Lee,Nigel J. Brunskill,Laura J. Gray,Rupert Major,James Medcalf,Gabriel Chodick,Cheli Melzer Cohen,Jack F.M. Wetzels,Peter J. Blankestijn,Arjan D. van Zuilen,Lesley A. Inker,Andrew S. Levey,Joachim H. Ix,Ian H. de Boer,Ronit Katz,Florian Kronenberg,Barbara Kollerits,Eberhard Ritz,Dorothea Nitsch,Girish N. Nadkarni,Lili Chan,Erwin P. Böttinger,Won-Suk Oh,Zhihong Liu,Haitao Zhang,Lihua Zhang,José Manuel Valdivielso,Marcelino Bermúdez-López,Milica Božić,Maite Caus,Juan Miguel Díaz‐Tocados,Bénédicte Stengel,Katsuyuki Miura,Hirotsugu Ueshima,Akira Okayama,Aya Kadota,Tomonori Okamura,Laura Solá,Alejandro Ferreiro,José Luis Santiago,Pablo Ríos,Liliana Gadola,Ricardo Silvariño,Takayoshi Ohkubo,Michihiro Satoh,Hirohito Metoki,Masahiro Kikuya,Elizabeth L. Ciemins,Jeff T. Mohl,Robert G. Nelson,Robert L. Hanson,Helen C. Looker,Ron T. Gansevoort,Lyanne M. Kieneker,Stephan J. L. Bakker,Olivier Moranne,Cécile Couchoud,David Shepherd,Simerjot K Jassal,Jaclyn Bergstrom,Csaba P. Kövesdy,Keiichi Sumida,Prabin Shrestha,Orlando M. Gutiérrez,Katharine L. Cheung,Paul Muntner,Titilayo O. Ilori,Michelle J. Pena,Hiddo JL Heerspink,Edouard L. Fu,Carl‐Gustaf Elinder,Peter Bárány,Juan Jesús Carrero,Marie Evans,Charumathi Sabanayagam,Ching‐Yu Cheng,Tien Yin Wong,C Yuen,William G. Herrington,Natalie Staplin,Martin J Landray,Colin Baigent,Philip A. Kalra,Rajkumar Chinnadurai,Darren Green,Smeeta Sinha,James Ritchie,Frank L.J. Visseren,Pascal Burger,M H Emmelot,Berend J. van Welzen,Oommen John,Balaji Gummidi,Arpita Ghosh,David Naimark,Navdeep Tangri,Chi Pang Wen,Min‐Kuang Tsai,Yoshiyuki Ueno,Masafumi Watanabe,Kazunobu Ichikawa,Mohammadhassan Mirbolouk,Fereidoun Azizi,Farzad Hadaegh,Farhad Hosseinpanah,Wen Shi,Dan E. Arking,Johan Ärnlöv,Anders Larsson,Vilmantas Giedraitis,Patrick B. Mark,Jamie P. Traynor,Michael L. Sullivan,Jennifer S. Lees,Jae Won Yang,Jae il Shin,Jun Young Lee,Jae seok Kim,Henk J.G. Bilo,Peter R. van Dijk,Mireille A. Edens,Joep Dille,Shoshana H. Ballew,Juan Jesús Carrero,Morgan E. Grams,Jingsha Chen,Aditya Surapaneni,Morgan E. Grams,Josef Coresh,Kunihiro Matsushita,Shoshana H. Ballew,Yingying Sang,Aditya Surapaneni,Natália Alencar de Pinho,Amanda Anderson,Lawrence J. Appel,Johan Ärnlöv,Fereidoun Azizi,Nisha Bansal,Samira Bell,Henk J.G. Bilo,Nigel J. Brunskill,Juan Jesús Carrero,Steven J. Chadban,John Chalmers,Jing Chen,Elizabeth L. Ciemins,Massimo Círillo,Natalie Ebert,Marie Evans,Alejandro Ferreiro,Edouard L. Fu,Masafumi Fukagawa,Jamie A. Green,Orlando M. Gutiérrez,William G. Herrington,Shih‐Jen Hwang,Lesley A. Inker,Kunitoshi Iseki,Tazeen H. Jafar,Simerjot K Jassal,Vivekanand Jha,Aya Kadota,Ronit Katz,Anna Köttgen,Tsuneo Konta,Florian Kronenberg,Brian J. Lee,Jennifer S. Lees,Adeera Levin,Helen C. Looker,Rupert Major,Cheli Melzer Cohen,Makiko Mieno,Mariko Miyazaki,Olivier Moranne,Isao Muraki,David Naimark,Dorothea Nitsch,Won-Suk Oh,Michelle J. Pena,Tanjala S. Purnell,Charumathi Sabanayagam,Michihiro Satoh,Simon Sawhney,Elke Schaeffner,Ben Schöttker,Jenny I. Shen,Michael G. Shlipak,Smeeta Sinha,Bénédicte Stengel,Keiichi Sumida,Marcello Tonelli,José Manuel Valdivielso,Arjan D. van Zuilen,Frank L.J. Visseren,Angela Yee‐Moon Wang,Chi-Pang Wen,David C. Wheeler,Hiroshi Yatsuya,Kunihiro Yamagata,Jae Won Yang,Ann Young,Haitao Zhang,Luxia Zhang,Andrew S. Levey,Ron T. Gansevoort
出处
期刊:JAMA [American Medical Association]
卷期号:330 (13): 1266-1266 被引量:51
标识
DOI:10.1001/jama.2023.17002
摘要

Importance Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. Objective To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. Design, Setting, and Participants Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. Exposures The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). Main Outcomes and Measures The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. Results Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m 2 (SD, 22 mL/min/1.73 m 2 ) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m 2 (SD, 22 mL/min/1.73 m 2 ) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m 2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m 2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]). Conclusions and Relevance In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.
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