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Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis
Open accessAbstract
Background Hypertension is the most prevalent comorbidity in individuals with chronic kidney disease (CKD). It is unknown, however, whether the association of the CKD measures, estimated glomerular filtration rate (eGFR) and albuminuria, with mortality or end-stage renal disease (ESRD) differs by hypertensive status. Methods We performed a meta-analysis of 45 cohorts (25 general population, 7 high-risk and 13 CKD cohorts), including 1,127,656 participants (364,344 with hypertension). Adjusted hazard ratios (HRs) for all-cause mortality (84,078 deaths from 40 cohorts) and ESRD (7,587 events from 21 cohorts) by hypertensive status were obtained for each study and pooled using random-effects models. Findings Low eGFR and high albuminuria were associated with mortality in both non-hypertensive and hypertensive individuals in the general population and high-risk cohorts. Mortality risk was higher in hypertensives as compared to non-hypertensives at preserved eGFR but a steeper relative risk gradient among non-hypertensives than hypertensives at eGFR range 45-75 ml/min/1.73m2 led to similar mortality risk at lower eGFR. With a reference eGFR of 95 mL/min/1.73m2 in each group to explicitly assess interaction, adjusted HR for all-cause mortality at eGFR 45 mL/min/1.73m2 was 1.77 (95% CI, 1.57-1.99) in non-hypertensives versus 1.24 (1.11-1.39) in hypertensives (P for overall interaction =0.0003). Similarly, for albumin-creatinine ratio (ACR) of 300 mg/g (vs. 5 mg/g), HRs were 2.30 (1.98-2.68) in non-hypertensives versus 2.08 (1.84-2.35) in hypertensives (P for overall interaction=0.019). Similar results were observed for cardiovascular mortality. The associations of eGFR and albuminuria with ESRD, however, did not differ by hypertensive status. Results in CKD cohorts were comparable to results in general and high-risk population cohorts. Interpretation Low eGFR and elevated albuminuria were more strongly associated with mortality among individuals without hypertension than in those with hypertension, but the associations with ESRD were similar. CKD should be considered at least an equally relevant risk factor for mortality and ESRD in non-hypertensive as it is in hypertensive individuals. Funding The US National Kidney Foundation (sources include Abbott and Amgen).
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A New Equation to Estimate Glomerular Filtration Rate
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. (., Castro, A. F., Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-9-200905050-00006 · Cited by 25,603
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Self-citationPrevalence of Chronic Kidney Disease in the United States
Coresh, J., Selvin, E., Stevens, L. A., Manzi, J., Kusek, J. W., Eggers, P., Van Lente, F., & Levey, A. S. (2007) · JAMA · doi:10.1001/jama.298.17.2038 · Cited by 4,895
Self-citationLevey, A. S., de Jong, P. E., Coresh, J., El Nahas, M., Astor, B. C., Matsushita, K., Gansevoort, R. T., Kasiske, B. L., & Eckardt, K.-U. (2011) · Kidney International · doi:10.1038/ki.2010.483 · Cited by 2,345
Self-citationLevey, A. S., Coresh, J., Greene, T., Marsh, J., Stevens, L. A., Kusek, J. W., Van Lente, F., & for Chronic Kidney Disease Epidemiology Collaboration (2007) · Clinical Chemistry · doi:10.1373/clinchem.2006.077180 · Cited by 1,855
Self-citationMancia, G., De Backer, G., Dominiczak, A., Cifkova, R., Fagard, R., Germano, G., Grassi, G., Heagerty, A. M., Kjeldsen, S. E., Laurent, S., et al. (2007) · Journal of Hypertension · doi:10.1097/hjh.0b013e3282f0580f · Cited by 1,837
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Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention
Gansevoort, R. T., Correa-Rotter, R., Hemmelgarn, B. R., Jafar, T. H., Heerspink, H. J. L., Mann, J. F., Matsushita, K., & Wen, C. P. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60595-4 · Cited by 2,213
Self-citationThe Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019)
Umemura, S., Arima, H., Arima, S., Asayama, K., Dohi, Y., Hirooka, Y., Horio, T., Hoshide, S., Ikeda, S., Ishimitsu, T., et al. (2019) · Hypertension Research · doi:10.1038/s41440-019-0284-9 · Cited by 1,880
Self-citationFox, C. S., Matsushita, K., Woodward, M., Bilo, H. J., Chalmers, J., Heerspink, H. J. L., Lee, B. J., Perkins, R. M., Rossing, P., Sairenchi, T., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61350-6 · Cited by 1,401
Self-citationTangri, N., Grams, M. E., Levey, A. S., Coresh, J., Appel, L. J., Astor, B. C., Chodick, G., Collins, A. J., Djurdjev, O., Elley, C. R., et al. (2016) · JAMA · doi:10.1001/jama.2015.18202 · Cited by 737
Self-citationLevey, A. S., Inker, L. A., Matsushita, K., Greene, T., Willis, K., Lewis, E., de Zeeuw, D., Cheung, A. K., & Coresh, J. (2014) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2014.07.030 · Cited by 620
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Metadata
- Authors
- Mahmoodi, B. K., Matsushita, K., Woodward, M., Blankestijn, P. J., Cirillo, M., Ohkubo, T., Rossing, P., Sarnak, M. J., Stengel, B., Yamagishi, K., Yamashita, K., Zhang, L., Coresh, J., de Jong, P. E., & Astor, B. C.
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2012-11
- Volume
- 380
- Issue
- 9854
- Pages
- 1649-1661
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2613325828
- Cited by
- 452
- References
- 33
- FWCI
- 5.84
- Type
- journal article
- Language
- en
- Open access
- green
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- Mahmoodi, B. K., Matsushita, K., Woodward, M., Blankestijn, P. J., Cirillo, M., Ohkubo, T., Rossing, P., Sarnak, M. J., Stengel, B., Yamagishi, K., Yamashita, K., Zhang, L., Coresh, J., de Jong, P. E., & Astor, B. C. (2012). Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. The Lancet. https://doi.org/10.1016/s0140-6736(12)61272-0
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