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

被引：919

作者：

Fox, Caroline S. ^{[1
,2
,3
,4
]}

Matsushita, Kunihiro ^{[5
]}

Woodward, Mark ^{[5
,6
]}

Bilo, Henk J. G. ^{[7
]}

Chalmers, John ^{[6
]}

Lambers Heerspink, Hiddo J. ^{[8
]}

Lee, Brian J. ^{[10
]}

Perkins, Robert M. ^{[11
]}

Rossing, Peter ^{[12
,13
]}

Sairenchi, Toshimi ^{[14
,15
]}

Tonelli, Marcello ^{[16
]}

Vassalotti, Joseph A. ^{[17
]}

Yamagishi, Kazumasa ^{[15
,18
,19
]}

Coresh, Josef ^{[5
]}

de Jong, Paul E. ^{[9
]}

Wen, Chi-Pang ^{[20
,21
]}

Nelson, Robert G. ^{[22
]}

机构：

[1] NHLBI, Framingham Heart Study, Framingham, MA USA

[2] Ctr Populat Studies, Framingham, MA USA

[3] Brigham & Womens Hosp, Div Endocrinol, Boston, MA 02115 USA

[4] Harvard Univ, Sch Med, Boston, MA USA

[5] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA

[6] Univ Sydney, George Inst Glocal Hlth, Sydney, NSW 2006, Australia

[7] Isala Clin, Dept Internal Med, Zwolle, Netherlands

[8] Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharmacol, Groningen, Netherlands

[9] Univ Groningen, Univ Med Ctr Groningen, Dept Nephrol, Groningen, Netherlands

[10] Moanalua Med Ctr, Honolulu, HI USA

[11] Geisinger Med Ctr, Dept Nephrol, Danville, PA 17822 USA

[12] Steno Diabet Ctr, DK-2820 Gentofte, Denmark

[13] Univ Aarhus, HEALTH, Aarhus, Denmark

[14] Dokkyo Med Univ, Sch Med, Dept Publ Hlth, Mibu, Tochigi, Japan

[15] Ibaraki Hlth Serv Assoc, Mito, Ibaraki, Japan

[16] Univ Alberta, Dept Med, Edmonton, AB, Canada

[17] Natl Kidney Fdn, New York, NY USA

[18] Univ Tsukuba, Fac Med, Dept Publ Hlth Med, Tsukuba, Ibaraki, Japan

[19] Osaka Med Ctr Hlth Sci & Promot, Osaka, Japan

[20] China Med Univ Hosp, Taichung, Taiwan

[21] Natl Hlth Res Inst, Inst Populat Hlth Sci, Zhunan, Taiwan

[22] NIDDKD, NIH, Phoenix, AZ USA

来源：

LANCET | 2012年 / 380卷 / 9854期

基金：

美国国家卫生研究院;

关键词：

GLOMERULAR-FILTRATION-RATE; COLLABORATIVE METAANALYSIS; HIGHER ALBUMINURIA; ALL-CAUSE; ESTIMATED GFR; RISK; PREVALENCE; PROTEINURIA; PREDICTION; EQUATION;

D O I：

10.1016/S0140-6736(12)61350-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Chronic kidney disease is characterised by low estimated glomerular fi ltration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modifi ed 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 highrisk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and highrisk 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-tocreatinine ratio (ACR). With fi xed 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 m y [vs 95 mL/min per 1.73 m y], HR 1.35; 95% CI 1.18-1.55; vs 1.33; 1.19-1.48 and at ACR 30 mg/g [vs 5 mg/g], 1.50; 1.35-1.65 vs 1.52; 1.38-1.67). The overall interactions were not signifi cant. We identifi ed much the same fi ndings 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.

引用

页码：1662 / 1673

页数：12

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