Document Detail


Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis.
MedLine Citation:
PMID:  23013600     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2012-09-24
Journal Detail:
Title:  Lancet     Volume:  380     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  2012-12-03     Revised Date:  2014-04-22    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1649-61     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
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
Grant Support
ID/Acronym/Agency:
CZH/4/656//Chief Scientist Office; HHSN268201100005C/HL/NHLBI NIH HHS; HHSN268201100006C/HL/NHLBI NIH HHS; HHSN268201100007C/HL/NHLBI NIH HHS; HHSN268201100008C/HL/NHLBI NIH HHS; HHSN268201100009C/HL/NHLBI NIH HHS; HHSN268201100010C/HL/NHLBI NIH HHS; HHSN268201100011C/HL/NHLBI NIH HHS; HHSN268201100012C/HL/NHLBI NIH HHS; HHSN268201200036C/HL/NHLBI NIH HHS; K23 DK002904/DK/NIDDK NIH HHS; K23 DK067303/DK/NIDDK NIH HHS; N01 HC015103/HC/NHLBI NIH HHS; N01 HC025195/HC/NHLBI NIH HHS; N01 HC035129/HC/NHLBI NIH HHS; N01 HC045133/HC/NHLBI NIH HHS; N01 HC075150/HC/NHLBI NIH HHS; N01 HC085079/HC/NHLBI NIH HHS; N01 HC085086/HC/NHLBI NIH HHS; N01 HC095159/HC/NHLBI NIH HHS; N01 HC095169/HC/NHLBI NIH HHS; N01HC55222/HL/NHLBI NIH HHS; R01 AG007181/AG/NIA NIH HHS; R01 AG015928/AG/NIA NIH HHS; R01 AG020098/AG/NIA NIH HHS; R01 AG023629/AG/NIA NIH HHS; R01 AG027058/AG/NIA NIH HHS; R01 AG028507/AG/NIA NIH HHS; R01 DK031801/DK/NIDDK NIH HHS; R01 DK073217/DK/NIDDK NIH HHS; R01 HL043232-03/HL/NHLBI NIH HHS; R01 HL068140/HL/NHLBI NIH HHS; R01 HL080295/HL/NHLBI NIH HHS; U01 DK035073/DK/NIDDK NIH HHS; U01 NS041588/NS/NINDS NIH HHS; U10 EY006594/EY/NEI NIH HHS
Investigator
Investigator/Affiliation:
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:
Lancet. 2012 Nov 10;380(9854):1628-30   [PMID:  23013601 ]
Nat Rev Nephrol. 2012 Nov;8(11):611   [PMID:  23045229 ]
Lancet. 2013 Feb 16;381(9866):532-3   [PMID:  23415297 ]
Lancet. 2013 Feb 16;381(9866):531-2   [PMID:  23415295 ]
Lancet. 2013 Feb 16;381(9866):531   [PMID:  23415294 ]
Lancet. 2013 Feb 16;381(9866):531   [PMID:  23415296 ]
Erratum In:
Lancet. 2012 Nov 10;380(9854):1648

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