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Risk Factors for Prognosis in Patients With Severely Decreased GFR

journal contribution
posted on 14.06.2018, 15:29 by Marie Evans, Morgan E. Grams, Yingying Sang, Brad C. Astor, Pete J. Blankestijn, Nigel J. Brunskill, John F. Collins, Philip A. Kalra, Csaba P. Kovesdy, Adeera Levin, Patrick B. Mark, Olivier Moranne, Panduranga Rao, Pablo G. Rios, Markus P. Schneider, Varda Shalev, Haitao Zhang, Alex R. Chang, Ron T. Gansevoort, Kunihiro Matsushita, Luxia Zhang, Kai-Uwe Eckardt, Brenda Hemmelgarn, David C. Wheeler, CKD Prognosis Consortium
Introduction: Patients with chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m2 (corresponding to CKD stage G4+) comprise a minority of the overall CKD population but have the highest risk for adverse outcomes. Many CKD G4+ patients are older with multiple comorbidities, which may distort associations between risk factors and clinical outcomes. Methods: We undertook a meta-analysis of risk factors for kidney failure treated with kidney replacement therapy (KRT), cardiovascular disease (CVD) events, and death in participants with CKD G4+ from 28 cohorts (n = 185,024) across the world who were part of the CKD Prognosis Consortium. Results: In the fully adjusted meta-analysis, risk factors associated with KRT were time-varying CVD, male sex, black race, diabetes, lower eGFR, and higher albuminuria and systolic blood pressure. Age was associated with a lower risk of KRT (adjusted hazard ratio: 0.74; 95% confidence interval: 0.69-0.80) overall, and also in the subgroup of individuals younger than 65 years. The risk factors for CVD events included male sex, history of CVD, diabetes, lower eGFR, higher albuminuria, and the onset of KRT. Systolic blood pressure showed a U-shaped association with CVD events. Risk factors for mortality were similar to those for CVD events but also included smoking. Most risk factors had qualitatively consistent associations across cohorts. Conclusion: Traditional CVD risk factors are of prognostic value in individuals with an eGFR <30 ml/min per 1.73 m2, although the risk estimates vary for kidney and CVD outcomes. These results should encourage interventional studies on correcting risk factors in this high-risk population.

History

Citation

Kidney Int Rep, 2018, 3 (3), pp. 625-637

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

VoR (Version of Record)

Published in

Kidney Int Rep

Publisher

Elsevier

eissn

2468-0249

Acceptance date

08/01/2018

Copyright date

2018

Available date

14/06/2018

Publisher version

https://www.sciencedirect.com/science/article/pii/S246802491830007X?via=ihub

Notes

Corrigendum Evans M, Grams ME, Sang Y, et al., for the Chronic Kidney Disease Prognosis Consortium. Risk factors for prognosis in patients with severely decreased GFR. Kidney Int Rep. 2018;3:625–637 https://doi.org/10.1016/j.ekir.2018.08.009

Language

en

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