학술논문
Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium
Document Type
article
Author
Inker, Lesley A; Grams, Morgan E; Levey, Andrew S; Coresh, Josef; Cirillo, Massimo; Collins, John F; Gansevoort, Ron T; Gutierrez, Orlando M; Hamano, Takayuki; Heine, Gunnar H; Ishikawa, Shizukiyo; Jee, Sun Ha; Kronenberg, Florian; Landray, Martin J; Miura, Katsuyuki; Nadkarni, Girish N; Peralta, Carmen A; Rothenbacher, Dietrich; Schaeffner, Elke; Sedaghat, Sanaz; Shlipak, Michael G; Zhang, Luxia; van Zuilen, Arjan D; Hallan, Stein I; Kovesdy, Csaba P; Woodward, Mark; Levin, Adeera; Astor, Brad; Appel, Larry; Greene, Tom; Chen, Teresa; Chalmers, John; Arima, Hisatomi; Perkovic, Vlado; Yatsuya, Hiroshi; Tamakoshi, Koji; Li, Yuanying; Hirakawa, Yoshihisa; Matsushita, Kunihiro; Grams, Morgan; Sang, Yingying; Polkinghorne, Kevan; Chadban, Steven; Atkins, Robert; Djurdjev, Ognjenka; Liu, Lisheng; Zhao, Minghui; Wang, Fang; Wang, Jinwei; Ebert, Natalie; Martus, Peter; Tang, Mila; Heine, Gunnar; Emrich, Insa; Seiler, Sarah; Zawada, Adam; Nally, Joseph; Navaneethan, Sankar; Schold, Jesse; Shlipak, Michael; Sarnak, Mark; Katz, Ronit; Hiramoto, Jade; Iso, Hiroyasu; Yamagishi, Kazumasa; Umesawa, Mitsumasa; Muraki, Isao; Fukagawa, Masafumi; Maruyama, Shoichi; Hasegawa, Takeshi; Fujii, Naohiko; Wheeler, David; Emberson, John; Townend, John; Landray, Martin; Brenner, Hermann; Schöttker, Ben; Saum, Kai-Uwe; Fox, Caroline; Hwang, Shih-Jen; Köttgen, Anna; Schneider, Markus P; Eckardt, Kai-Uwe; Green, Jamie; Kirchner, H Lester; Chang, Alex R
Source
American Journal of Kidney Diseases. 73(2)
Subject
Language
Abstract
Rationale & objectiveChronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework.Study designCross-sectional individual participant-level analyses in a global consortium.Setting & study populations17 CKD and 38 general population and high-risk cohorts.Selection criteria for studiesCohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension.Data extractionData were obtained and analyzed between July 2015 and January 2018.Analytical approachWe modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses.ResultsThe CKD cohorts (n=254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n=1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years. There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 [95% CI, 2.68-3.97] to 8.91 [95% CI, 7.22-10.99] comparing eGFRs of 15 to 29 with eGFRs of 45 to 59mL/min/1.73m2), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 [95% CI, 0.60-0.99] to 1.92 [95% CI, 1.65-2.24] comparing urinary albumin-creatinine ratio > 300 vs < 30mg/g).LimitationsVariations in study era, health care delivery system, typical diet, and laboratory assays.ConclusionsLower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.