Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis

作者：Nitsch, Dorothea; Grams, Morgan; Sang, Yingying; Black, Corri; Cirillo, Massimo; Djurdjev, Ognjenka; Iseki, Kunitoshi; Jassal, Simerjot K.; Kimm, Heejin; Kronenberg, Florian; Oien, Cecilia M.; Levey, Andrew S.^*; Levin, Adeera; Woodward, Mark; Hemmelgarn, Brenda R.

来源：BMJ-British Medical Journal, 2013, 346(jan29 1): f324.

DOI：10.1136/bmj.f324

• CHRONIC KIDNEY-DISEASE
• CARDIOVASCULAR-DISEASE
• GENERAL-POPULATION
• COLLABORATIVE METAANALYSIS
• ESTIMATED GFR
• RISK-FACTORS
• ALL-CAUSE
• PREVALENCE
• WOMEN
• EQUATION

Objective To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. @@@ Design Random effects meta-analysis using pooled individual participant data. @@@ Setting 46 cohorts from Europe, North and South America, Asia, and Australasia. @@@ Participants 2 051 158 participants (54% women) from general population cohorts (n=1 861 052), high risk cohorts (n=151 494), and chronic kidney disease cohorts (n=38 612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of >= 50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (mg/g). @@@ Results Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (P-interaction<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (P-interaction<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk. @@@ Conclusions Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.

• 出版日期2013-1-29