학술논문
Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data
Document Type
article
Author
Matsushita, Kunihiro; Ballew, Shoshana H; Coresh, Josef; Arima, Hisatomi; Ärnlöv, Johan; Cirillo, Massimo; Ebert, Natalie; Hiramoto, Jade S; Kimm, Heejin; Shlipak, Michael G; Visseren, Frank LJ; Gansevoort, Ron T; Kovesdy, Csaba P; Shalev, Varda; Woodward, Mark; Kronenberg, Florian; Chalmers, John; Perkovic, Vlado; Grams, Morgan E; Sang, Yingying; Schaeffner, Elke; Martus, Peter; Levin, Adeera; Djurdjev, Ognjenka; Tang, Mila; Heine, Gunnar; Seiler, Sarah; Zawada, Adam; Emrich, Insa; Sarnak, Mark; Katz, Ronit; Brenner, Hermann; Schöttker, Ben; Rothenbacher, Dietrich; Saum, Kai-Uwe; Köttgen, Anna; Schneider, Markus; Eckardt, Kai-Uwe; Green, Jamie; Kirchner, H Lester; Chang, Alex R; Black, Corri; Marks, Angharad; Prescott, Gordon; Clark, Laura; Fluck, Nick; Jee, Sun Ha; Mok, Yejin; Chodick, Gabriel; Wetzels, Jack FM; Blankestijn, Peter J; van Zuilen, Arjan D; Bots, M; Peralta, Carmen; Hiromoto, Jade; Bottinger, Erwin; Nadkarni, Girish N; Ellis, Stephen B; Nadukuru, Rajiv; Kenealy, Timothy; Elley, C Raina; Collins, John F; Drury, Paul L; Bakker, Stephan JL; Heerspink, Hiddo J Lambers; Jassal, Simerjot K; Bergstrom, Jaclyn; Ix, Joachim H; Barrett-Connor, Elizabeth; Kalantar-Zadeh, Kamyar; Carrero, Juan J; Gasparini, Alessandro; Qureshi, Abdul Rashid; Barany, Peter; Algra, Ale; van der Graaf, Yolanda; Evans, Marie; Segelmark, Mårten; Stendahl, Maria; Schön, Staffan; Tangri, Navdeep; Sud, Maneesh; Naimark, David; Lannfelt, Lars; Larsson, Anders; Hallan, Stein; Levey, Andrew S; Chen, Jingsha; Kwak, Lucia
Source
The Lancet Diabetes & Endocrinology. 5(9)
Subject
Language
Abstract
BackgroundSome evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease.MethodsIn this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics.FindingsWe analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m2, adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m2 and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m2. Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41-1·59) at an ACR of 30 mg/g and 2·28 (2·12-2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00-4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90-6·77] for incident peripheral artery disease and 10·61 [5·70-19·77] for amputation in eGFR