ArticlesAssociations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis
Introduction
Chronic kidney disease is a global public health problem,1, 2 affecting 10–16% of the adult population worldwide.3, 4, 5, 6, 7, 8 Decreased estimated glomerular filtration rate (eGFR) and increased urinary albumin excretion predict the major health outcomes of this disorder, including end-stage renal disease (ESRD) and death, across a wide range of settings.9, 10, 11, 12, 13 Whether these associations are consistent across diseases or are differentially modified by the presence or absence of a particular disease or condition is uncertain.
Diabetes is the leading cause of chronic kidney disease in the developed world,14, 15 and people with diabetes and chronic kidney disease have a greatly increased risk of all-cause mortality, cardiovascular mortality, and kidney failure. We did a meta-analysis to assess whether the associations between eGFR, albuminuria, and mortality and kidney outcomes are the same in individuals with and without diabetes.
Section snippets
Study selection criteria
Sources of data for the Chronic Kidney Disease Prognosis Consortium are described elsewhere.9, 10, 11, 12, 16 Briefly, we included studies that had at least 1000 participants (not applied to studies that predominantly included patients with chronic kidney disease), baseline information about eGFR and albuminuria, and at least 50 events for each outcome of interest. We restricted our analyses to participants aged at least 18 years. Sample size varies slightly compared with our accompanying
Results
Table 1 and appendix pp 1–3 show baseline characteristics from individual studies. 1 024 977 participants were included, of whom 128 505 (13%) had diabetes. Participants with diabetes were generally older than those without diabetes and had a higher prevalence of hypertension, hypercholesterolaemia, and cardiovascular disease.
In the 30 combined general population and high-risk 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
Discussion
Individuals with diabetes have a higher risk of all-cause and cardiovascular mortality than do those without diabetes across the range of eGFR and ACR. However, relative risks of these health outcomes according to measures of kidney disease are much the same in individuals with and without diabetes. The use of clinically relevant cutoff points showed the importance of both eGFR and ACR with respect to each of these outcomes. When we did similar analyses for ESRD in chronic kidney disease
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