Estimated Glomerular Filtration Rate, All-Cause Mortality and Cardiovascular Diseases Incidence in a Low Risk Population: The MATISS Study

Donfrancesco, Chiara; Palleschi, Simonetta; Palmieri, Luigi; Rossi, Barbara; Noce, Cinzia Lo; Pannozzo, Fabio; Spoto, Belinda; Tripepi, Giovanni; Zoccali, Carmine; Giampaoli, Simona

doi:10.1371/journal.pone.0078475

Cited by 42 publications

(54 citation statements)

References 32 publications

(24 reference statements)

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“…These observations are consistent with previous studies reporting a J-shaped association between serum creatininebased eGFR and mortality. [11][12][13][14][15][16][17] The J-shaped association between eGFR and mortality has been explained by the overestimation of the true GFR in individuals in the high-risk group because of muscle wasting. Previous studies defined high GFR as above a certain absolute value, irrespective of age, sex, and muscle mass, and could not exclude the possibility of the confounding effects of muscle wasting in the high-risk group or the misclassification of normal GFR in young subjects as higher GFR or higher GFR in older subjects as normal GFR.…”

Section: Discussionmentioning

confidence: 99%

“…However, the increased mortality associated with a higher GFR was commonly regarded as an overestimation of GFR because of muscle wasting in a high-risk group. [11][12][13][14][15][16][17] The disappearance of the J-shaped association between GFR and mortality within a younger age group in the higher GFR range is considered as supporting evidence for the overestimation of the true GFR …”

mentioning

confidence: 99%

“…7 The differential effect of smoking on the association between RHF and mortality should be evaluated. 17 No study has yet evaluated the long-term clinical consequences of RHF taking age, muscle mass, and smoking status into account.…”

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confidence: 99%

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Renal Hyperfiltration as a Novel Marker of All-Cause Mortality

Park

Yoon

Lim

et al. 2015

Journal of the American Society of Nephrology

113

136

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Although renal hyperfiltration (RHF) or an abnormal increase in GFR has been associated with many lifestyles and clinical conditions, including diabetes, its clinical consequence is not clear. RHF is frequently considered to be the result of overestimating true GFR in subjects with muscle wasting. To evaluate the association between RHF and mortality, 43,503 adult Koreans who underwent voluntary health screening at Seoul National University Hospital between March of 1995 and May of 2006 with baseline GFR$60 ml/min per 1.73 m 2 were followed up for mortality until December 31, 2012. GFR was estimated with the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and RHF was defined as GFR.95th percentile after adjustment for age, sex, muscle mass, and history of diabetes and/or hypertension medication.Muscle mass was measured with bioimpedance analysis at baseline. During the median follow-up of 12.4 years, 1743 deaths occurred. The odds ratio of RHF in participants with the highest quartile of muscle mass was 1.31 (95% confidence interval [95% CI], 1.11 to 1.54) compared with the lowest quartile after adjusting for confounding factors, including body mass index. The hazard ratio of all-cause mortality for RHF was 1.37 (95% CI, 1.11 to 1.70) by Cox proportional hazards model with adjustment for known risk factors, including smoking. These data suggest RHF may be associated with increased all-cause mortality in an apparently healthy population. The possibility of RHF as a novel marker of all-cause mortality should be confirmed. Although CKD is a well known risk factor for all-cause or cardiovascular mortality, 1 the clinical consequences of an abnormally high GFR or renal hyperfiltration (RHF) have not been adequately evaluated. On the basis of several cross-sectional studies, RHF is known to be associated with various medical conditions, such as diabetes, 2,3 hypertension, 4 obesity, 5 prehypertension, and prediabetes, 6 as well as lifestyle factors, such as smoking, 7 lack of physical activity, 8 and low aerobic fitness. 9 Although these conditions are well known risk factors for early mortality, 10 the clinical implications of RHF remain unclear.Several cohort studies and meta-analyses have reported a J-shaped association between GFR and all-cause and cardiovascular mortality. However, the increased mortality associated with a higher GFR was commonly regarded as an overestimation of GFR because of muscle wasting in a high-risk group. [11][12][13][14][15][16][17] The disappearance of the J-shaped association between GFR and mortality within a younger age group in the higher GFR range is considered as supporting evidence for the overestimation of the true GFR

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Renal Hyperfiltration as a Novel Marker of All-Cause Mortality

Park

Yoon

Lim

et al. 2015

Journal of the American Society of Nephrology

113

136

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“…Esse viés de sobrevivência influencia nos achados observacionais, que pode representar inadequadamente a população doente por apenas incluir aqueles que acessaram o tratamento em tempo hábil. A progressão de nefropatias sem tratamento adequado aumenta o risco de desfechos negativos mortalidade 40,45,46 .…”

Section: 20unclassified

Prevalência de doença renal crônica em adultos no Brasil: revisão sistemática da literatura

Penha²,

et al. 2017

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Resumo Introdução A doença renal crônica é um problema global de saúde pública, e no Brasil sua prevalência é incerta. Objetivo Estimar a prevalência de doença renal crônica em adultos do Brasil. Método Realizou-se revisão sistemática com buscas no MEDLINE, Embase e outras bases. Dois pesquisadores selecionaram os estudos, extraíram os dados e avaliaram a qualidade. Resultados Incluímos 16 estudos: inquéritos populacionais que utilizaram critério autorreferido encontraram prevalência nacional de 4,57% (1998) a 1,43% (2013); naqueles que usaram hipercreatininemia, a prevalência foi 3,46% em Bambuí (1997) e 3,13% em Salvador (2000). Estudos com amostras não representativas usaram critérios clínico-laboratoriais e tiveram maiores prevalências: entre 6,26-7,26% em campanhas de saúde (2002-2010), 8,94% em servidores públicos (2008-2010), 9,62% em usuários de laboratório privado (2003), 27,20% em pacientes hospitalizados (2013) e 1,35-13,63% na atenção primária (2010-2012). Pacientes em terapia dialítica representam 0,05% da população. Discussão Os estudos com representatividade populacional não aferiram a doença adequadamente, e investigações com melhores critérios diagnósticos tiveram amostragem por conveniência. A heterogeneidade entre pesquisas inviabilizou a elaboração de meta-análise. Conclusão A prevalência de doença renal crônica variou de acordo com o método empregado na definição da doença. Pelos critérios populacionais, 3-6 milhões teriam a doença. Aproximadamente 100.000 recebem diálise no Brasil.

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“…In 1999 diabetes was recognized as a coronary heart disease equivalent [2] and more recently it has been well recognized that the presence of diabetes increases the risk of heart failure by two to four fold [3]. Moreover, among diabetic and cardiovascular patients, renal dysfunction is common, and associated with a worse prognosis [4,5]. In this setting, albuminuria is not only a marker of renal disease but is also an important risk factor for CVD progression [6] and more recently it has been recognized as a risk factor for the development of heart failure [7].…”

Section: Introductionmentioning

confidence: 99%