A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury

Abstract

Background Diabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain. Study Design Meta-analysis of cohort studies. Setting & Population 8 general population (1,285,045 participants) and 5 CKD (79,519 participants) cohorts. Selection Criteria for Studies Cohorts participating in the CKD Prognosis Consortium. Predictors Diabetes and hypertension status, eGFR by the CKD Epidemiology Collaboration 2009 creatinine equation, urine ACR, and interactions. Outcome Hospitalization with AKI, using Cox proportional hazards models to estimate hazard ratios (HR) of AKI and random effects meta-analysis to pool results. Results Over a mean follow-up period of 4 years, there were 16,480 episodes of AKI in the general population and 2,087 episodes in the CKD cohorts. Low eGFR and high ACR were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR 80 mL/min/1.73m2 in non-diabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared to non-diabetic patients. The risk gradient for AKI with lower eGFR was greater in those without diabetes than with diabetes, but similar with higher ACR in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFR greater than 60 ml/min/1.73m2 than those without hypertension. However, the risk gradients for AKI with both lower eGFR and higher ACR were greater for those without than with hypertension. Limitations AKI identified by diagnostic code. Conclusions Lower eGFR and higher ACR are associated with higher risks of AKI among individuals with or without either diabetes or hypertension.

Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data

“…Consistent with large meta-analyses of hospitalized AKI, older age, male sex, African American race, diabetes, and hypertension were associated with AKI overall and in most surgery types. 33, 34 In contrast, the relationship between eGFR and AKI was slightly different than previous work. 33-35 In our study, eGFR had a U-shaped association with post-operative AKI, with lower levels below 90 ml/min/1.73 m 2 and higher levels at or above 90 ml/min/1.73 m 2 associated with higher AKI risk.…”

AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms

“…James et al conducted a meta-analysis in 2015 showing that CKD was a risk factor of developing AKI in patients with diabetes or hypertension 22 . Consistently, CKD was shown to be an independent risk factor of AKI in patients of major cardiac surgery 23 .…”

The Role of Acute Kidney Injury in Chronic Kidney Disease

“…20 A number of meta-analyses have now been published characterizing how AKI risk is independently determined by severity of CKD—defined on two orthogonal dimensions—estimated GFR and albuminuria 21 (Figure 1) and describing how associations may vary in important subgroups. 22,23 …”