A meta-analysis of the association of estimated GFR, albuminuria, diabetes mellitus, and hypertension with acute kidney injury
Open accessAbstract
Background Diabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain. Study Design Meta-analysis of cohort studies. Setting & Population 8 general population (1,285,045 participants) and 5 CKD (79,519 participants) cohorts. Selection Criteria for Studies Cohorts participating in the CKD Prognosis Consortium. Predictors Diabetes and hypertension status, eGFR by the CKD Epidemiology Collaboration 2009 creatinine equation, urine ACR, and interactions. Outcome Hospitalization with AKI, using Cox proportional hazards models to estimate hazard ratios (HR) of AKI and random effects meta-analysis to pool results. Results Over a mean follow-up period of 4 years, there were 16,480 episodes of AKI in the general population and 2,087 episodes in the CKD cohorts. Low eGFR and high ACR were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR 80 mL/min/1.73m2 in non-diabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared to non-diabetic patients. The risk gradient for AKI with lower eGFR was greater in those without diabetes than with diabetes, but similar with higher ACR in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFR greater than 60 ml/min/1.73m2 than those without hypertension. However, the risk gradients for AKI with both lower eGFR and higher ACR were greater for those without than with hypertension. Limitations AKI identified by diagnostic code. Conclusions Lower eGFR and higher ACR are associated with higher risks of AKI among individuals with or without either diabetes or hypertension.
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People with diabetes are at higher risk of acute kidney injury than those without diabetes.
“People with diabetes are at higher risk of AKI than those without diabetes (28).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [28]
People with diabetes are at higher risk of AKI than those without diabetes.
“People with diabetes are at higher risk of AKI than those without diabetes (27).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [27]
Individualization of potassium intake may be necessary to manage serum potassium concentrations.
“Restriction of dietary sodium (to <2,300 mg/day) may be useful to manage blood pressure and reduce cardiovascular risk (51,52), and individualization of potassium intake may be necessary to manage serum potassium concentrations (27,38,39).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [27]
The Methods (Exposure variables and Effect modification variables; pages unavailable) describe kidney-function measures, albuminuria, diabetes, and hypertension, not dietary potassium or serum potassium management. Searches for individualized potassium intake and for dietary potassium, serum potassium, and hyperkalemia found no passage addressing the attributed advice. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPatients with reduced glomerular filtration are at increased risk of hyperkalemia and acute kidney injury.
“Therefore, serum creatinine and potassium should be monitored during treatment with an ACE inhibitor, ARB, or diuretic, particularly among patients with reduced glomerular fi ltration who are at increased risk of hyperkalemia and AKI (77,78,80).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [80]
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Major comorbid disease processes associated with increased incidence of acute kidney injury
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Impact of Acute Kidney Injury and CKD on Adverse Outcomes in Critically Ill Septic Patients
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Fibrosis, the Bad Actor in Cardiorenal Syndromes: Mechanisms Involved
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Recent advances in molecular mechanisms of acute kidney injury in patients with diabetes mellitus
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Self-citationAssociation of Albuminuria Levels With the Prescription of Renin-Angiotensin System Blockade
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Self-citationCapítulo 14 – Crise Hipertensiva
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- Authors
- James, M. T., Grams, M. E., Woodward, M., Elley, C. R., Green, J. A., Wheeler, D. C., de Jong, P., Gansevoort, R. T., Levey, A. S., Warnock, D. G., Sarnak, M. J., Tonelli, M., Hemmelgarn, B. R., James, M. T., Turin, T. C., Coresh, J., Matsushita, K., Grams, M., Sang, Y., Shlipak, M., Sarnak, M. J., Katz, R., Wheeler, D. C., Emberson, J., Landray, M. J., Townend, J. N., Green, J., Kirchner, H. L., Perkins, R., Chang, A. R., Romundstad, S., Aasarød, K., Øien, C. M., Hallan, S., Smith, D. H., Thorp, M. L., Johnson, E. S., Chodick, G., Herzel, E., Katz, R., Shalev, V., Gansevoort, R. T., Bakker, S. J. L., Lambers Heerspink, H. J., van der Harst, P., Jee, S. H., Kimm, H., Mok, Y., Tangri, N., Naimark, D., Ärnlöv, J., Larsson, A., Lannfelt, L., Kovesdy, C. P., Kalantar-Zadeh, K., Coresh, J., Grams, M., Matsushita, K., Gansevoort, R. T., de Jong, P. E., Iseki, K., Levey, A. S., Sarnak, M. J., Stengel, B., Warnock, D., Woodward, M., Ballew, S. H., Coresh, J., Grams, M., Matsushita, K., Sang, Y., & Woodward, M.
- Affiliations
- University of Auckland (NZ)
- University of Alabama at Birmingham (US)
- ORCID
- Elley, C. Raina
- Tonelli, Marcello
- Hemmelgarn, Brenda R.
- Turin, Tanvir Chowdhury
- Shlipak, Michael
- Katz, Ronit
- Emberson, Jonathan
- Landray, Martin J.
- Chang, Alex R.
- Romundstad, Solfrid
- Hallan, Stein
- Smith, David H.
- Johnson, Eric S.
- Chodick, Gabriel
- Herzel, Esma
- Katz, Rachel
- Shalev, Varda
- Bakker, Stephan J.L.
- Jee, Sun Ha
- Kimm, Heejin
- Mok, Yejin
- Tangri, Navdeep
- Naimark, David
- Ärnlöv, Johan
- Larsson, Anders
- Kovesdy, Csaba P.
- Iseki, Kunitoshi
- Ballew, Shoshana H.
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 66
- Issue
- 4
- Pages
- 602-612
- ISSN
- 0272-6386 (ISSN-L)
- PMC
- PMC4594211
- OpenAlex
- W2155749392
- Semantic Scholar
- 30d93ba7ed24105c0a522b5b4ae742e98ebe627a
- Cited by
- 309
- References
- 36
- Citations by year
- 2026: 11 · 2025: 25 · 2024: 29 · 2023: 35 · 2022: 35 · 2021: 38 · 2020: 50 · 2019: 22 · 2018: 19 · 2017: 14 · 2016: 25 · 2015: 4
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100446-01)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- acute kidney injury, estimated glomerular filtration rate, albuminuria, urine albumin-creatinine ratio, diabetes mellitus, hypertension, chronic kidney disease, risk factors, hospitalization
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Female, Glomerular Filtration Rate, Humans, Hypertension, Kidney Failure, Chronic, Male, Middle Aged, Prognosis, Comorbidity, Incidence, Disease Progression, Renal Insufficiency, Chronic, Acute Kidney Injury
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