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

Abstract

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). ResultsRisks 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 RESEARCHof 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. IntroductionChronic kidney disease affects 10-16% of the general adult population in Asia, Europe, Australia, and the United States. [1][2][3][4][5][6] Chronic kidney disease, typically defined by reduced estimated glomerular filtration rate and/or albuminuria, is independently associated with an increased risk of all-cause mortality and cardiovascular mortality and progression to end stage renal disease. [7][8][9] Go and colleagues found in administrative healthcare data that estimated glomerular filtration rates <60 mL/min/1.73m2 were independently associated with hospitalisations, cardiovascular events, and death. 10 In a collaborative meta-analysis of general population cohorts we found that mortality rises exponentially with decreasing estimated glomerular filtration rate below 60 mL...

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