Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis

Abstract

Background Chronic kidney disease is characterised by low estimated glomerular filtration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modified by diabetes 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 end-stage renal disease (ESRD) associated with eGFR and albuminuria in individuals with and without diabetes. Findings We analysed data for 1 024 977 participants (128 505 with diabetes) from 30 general population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and high-risk cohorts with data for all-cause mortality, 75 306 deaths occurred during a mean follow-up of 8·5 years (SD 5·0). In the 23 studies with data for cardiovascular mortality, 21 237 deaths occurred from cardiovascular disease during a mean follow-up of 9·2 years (SD 4·9). In the general and high-risk cohorts, mortality risks were 1·2–1·9 times higher for participants with diabetes than for those without diabetes across the ranges of eGFR and albumin-to-creatinine ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes groups, HR of mortality outcomes according to lower eGFR and higher ACR were much the same in participants with and without diabetes (eg, for all-cause mortality at eGFR 45 mL/min per 1·73 m2 [νs 95 mL/min per 1·73 m2], HR 1·35; 95% CI 1·18–1·55; νs 1·33; 1·19–1·48 and at ACR 30 mg/g [νs 5 mg/g], 1·50; 1·35–1·65 νs 1·52; 1·38–1·67). The overall interactions were not significant. We identified much the same findings for ESRD in the chronic kidney disease cohorts. Interpretation Despite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes.

Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-cause mortality in Japanese patients with type 2 diabetes

“…On the contrary, allcause mortality, not cardiovascular events, was strongly associated with reduced eGFR \30 ml/min per 1.73 m 2 in normoalbuminuric diabetic patients in this present study. Supporting this notion, hazard ratios for all-cause mortality as well as cardiovascular mortality increased in normoalbuminuric diabetic patients with low GFR [19]. The FIELD study also revealed that normoalbuminuric patients with eGFR 30-59 ml/min per 1.73 m 2 had a higher risk of cardiovascular events, cardiovascular death, non-coronary heart disease deaths, death from any cause than normoalbuminuric patients with eGFR C60 ml/min per 1.73 m 2 [7].…”

Past Decline Versus Current eGFR and Subsequent Mortality Risk

“…Previous studies have shown that low eGFR measured at a single time point is an important risk factor for ACM. 3,5,[17][18][19] We sought to evaluate whether prior change in eGFR contributes independently to ACM prognosis in the clinical setting, where last eGFR value is known. Previous studies have investigated this association from a clinical trial perspective, adjusting for the first eGFR.…”

End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline

“…Figure 1 shows the multivariate-derived ESRD cumulative rates according to treatment type, patient age, diabetes, and hypertension, which, alongside year of surgery, were the most informative predictors of ESRD (Supplementary Table 1). ESRD is a life-threatening condition [4]. In young and healthy persons, the estimated risk of ESRD at 15 yr is 0.04% (95% CI, 0.008-0.09), reaching a peak of 0.3% (95% CI, 0.2-0.4) in healthy kidney donors [5].…”