| Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. | |
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MedLine Citation:
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PMID: 23013600 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hypertension is the most prevalent comorbidity in individuals with chronic kidney disease. However, whether the association of the kidney disease measures, estimated glomerular filtration rate (eGFR) and albuminuria, with mortality or end-stage renal disease (ESRD) differs by hypertensive status is unknown. METHODS: We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and ESRD associated with eGFR and albuminuria in individuals with and without hypertension. FINDINGS: We analysed data for 45 cohorts (25 general population, seven high-risk, and 13 chronic kidney disease) with 1,127,656 participants, 364,344 of whom had hypertension. Low eGFR and high albuminuria were associated with mortality irrespective of hypertensive status in the general population and high-risk cohorts. All-cause mortality risk was 1·1-1·2 times higher in individuals with hypertension than in those without hypertension at preserved eGFR. A steeper relative risk gradient in individuals without hypertension than in those with hypertension at eGFR range 45-75 mL/min per 1·73 m(2) led to much the same mortality risk at lower eGFR. With a reference eGFR of 95 mL/min per 1·73 m(2) in each group to explicitly assess interaction, adjusted HR for all-cause mortality at eGFR 45 mL/min per 1·73 m(2) was 1·77 (95% CI 1·57-1·99) in individuals without hypertension versus 1·24 (1·11-1·39) in those with hypertension (p for overall interaction=0·0003). Similarly, for albumin-creatinine ratio of 300 mg/g (vs 5 mg/g), HR was 2·30 (1·98-2·68) in individuals without hypertension versus 2·08 (1·84-2·35) in those with hypertension (p for overall interaction=0·019). We recorded much the same results for cardiovascular mortality. The associations of eGFR and albuminuria with ESRD, however, did not differ by hypertensive status. Results for chronic kidney disease cohorts were similar to those for general and high-risk population cohorts. INTERPRETATION: Chronic kidney disease should be regarded as at least an equally relevant risk factor for mortality and ESRD in individuals without hypertension as it is in those with hypertension. FUNDING: US National Kidney Foundation. |
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Authors:
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Bakhtawar K Mahmoodi; Kunihiro Matsushita; Mark Woodward; Peter J Blankestijn; Massimo Cirillo; Takayoshi Ohkubo; Peter Rossing; Mark J Sarnak; Bénédicte Stengel; Kazumasa Yamagishi; Kentaro Yamashita; Luxia Zhang; Josef Coresh; Paul E de Jong; Brad C Astor; |
Publication Detail:
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Type: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review Date: 2012-09-24 |
Journal Detail:
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Title: Lancet Volume: 380 ISSN: 1474-547X ISO Abbreviation: Lancet Publication Date: 2012 Nov |
Date Detail:
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Created Date: 2012-11-12 Completed Date: 2012-12-03 Revised Date: 2013-02-19 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: England |
Other Details:
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Languages: eng Pagination: 1649-61 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 Elsevier Ltd. All rights reserved. |
Affiliation:
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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Albuminuria / etiology, physiopathology Blood Pressure / physiology Cause of Death Chronic Disease Female Glomerular Filtration Rate / physiology Humans Hypertension / mortality*, physiopathology, urine Kidney Failure, Chronic / mortality*, physiopathology, urine Male Middle Aged Proportional Hazards Models Risk Factors |
| Investigator | |
Investigator/Affiliation:
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J Wright / ; L Appel / ; T Greene / ; B C Astor / ; J Chalmers / ; S MacMahon / ; M Woodward / ; H Arima / ; H Yatsuya / ; K Yamashita / ; H Toyoshima / ; K Tamakoshi / ; J Coresh / ; B C Astor / ; K Matsushita / ; Y Sang / ; R C Atkins / ; K R Polkinghorne / ; S Chadban / ; A Shankar / ; R Klein / ; B E K Klein / ; K E Lee / ; H Wang / ; F Wang / ; L Zhang / ; L Zuo / ; A Levin / ; O Djurdjev / ; M Tonelli / ; F M Sacks / ; G C Curhan / ; M Shlipak / ; C Peralta / ; R Katz / ; L Fried / ; H Iso / ; A Kitamura / ; T Ohira / ; K Yamagishi / ; T H Jafar / ; M Islam / ; J Hatcher / ; N Poulter / ; N Chaturvedi / ; M J Landray / ; J R Emberson / ; J N Townend / ; D C Wheeler / ; D Rothenbacher / ; H Brenner / ; H Müller / ; B Schöttker / ; C S Fox / ; S-J Hwang / ; J B Meigs / ; R M Perkins / ; N Fluck / ; L E Clark / ; G J Prescott / ; A Marks / ; C Black / ; M Cirillo / ; S Hallan / ; K Aasarød / ; C M Øien / ; M Radtke / ; F Irie / ; H Iso / ; T Sairenchi / ; K Yamagishi / ; D H Smith / ; J W Weiss / ; E S Johnson / ; M L Thorp / ; A J Collins / ; J A Vassalotti / ; S Li / ; S-C Chen / ; B J Lee / ; J F Wetzels / ; P J Blankestijn / ; A D van Zuilen / ; M Sarnak / ; A S Levey / ; V Menon / ; M Shlipak / ; M Sarnak / ; C Peralta / ; R Katz / ; H J Kramer / ; I H de Boer / ; F Kronenberg / ; B Kollerits / ; E Ritz / ; P Roderick / ; D Nitsch / ; A Fletcher / ; C Bulpitt / ; A Ishani / ; J D Neaton / ; M Froissart / ; B Stengel / ; M Metzger / ; J-P Haymann / ; P Houillier / ; M Flamant / ; B C Astor / ; J Coresh / ; K Matsushita / ; T Ohkubo / ; H Metoki / ; M Nakayama / ; M Kikuya / ; Y Imai / ; K Iseki / ; R G Nelson / ; W C Knowler / ; R T Gansevoort / ; P E de Jong / ; B K Mahmoodi / ; H Hillege / ; S K Jassal / ; E Barrett-Connor / ; J Bergstrom / ; H J Lambers Heerspink / ; B E Brenner / ; D de Zeeuw / ; D G Warnock / ; P Muntner / ; S Judd / ; W McClellan / ; S H Jee / ; H Kimm / ; J Jo / ; Y Mok / ; P Rossing / ; H-H Parving / ; N Tangri / ; D Naimark / ; C-P Wen / ; S-F Wen / ; C-K Tsao / ; M-K Tsai / ; J Ärnlöv / ; L Lannfelt / ; A Larsson / ; H J Bilo / ; H Joosten / ; N Kleefstra / ; K H Groenier / ; I Drion / ; B C Astor / ; J Coresh / ; R T Gansevoort / ; B R Hemmelgarn / ; P E de Jong / ; A S Levey / ; A Levin / ; K Matsushita / ; C-P Wen / ; M Woodward / ; S H Ballew / ; J Coresh / ; M Grams / ; B K Mahmoodi / ; K Matsushita / ; Y Sang / ; M Woodward / ; L Camarata / ; X Hui / ; J Seltzer / ; H Winegrad / |
| Comments/Corrections | |
Comment In:
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Lancet. 2013 Feb 16;381(9866):531
[PMID:
23415296
]
Lancet. 2013 Feb 16;381(9866):531 [PMID: 23415294 ] Lancet. 2013 Feb 16;381(9866):531-2 [PMID: 23415295 ] Lancet. 2013 Feb 16;381(9866):532-3 [PMID: 23415297 ] Lancet. 2012 Nov 10;380(9854):1628-30 [PMID: 23013601 ] Nat Rev Nephrol. 2012 Nov;8(11):611 [PMID: 23045229 ] |
Erratum In:
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Lancet. 2012 Nov 10;380(9854):1648 |
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