TY - JOUR
T1 - Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities
T2 - An Individual Participant Data Meta-analysis in a Global Consortium
AU - CKD Prognosis Consortium
AU - Inker, Lesley A.
AU - Grams, Morgan E.
AU - Levey, Andrew S.
AU - Coresh, Josef
AU - Cirillo, Massimo
AU - Collins, John F.
AU - Gansevoort, Ron T.
AU - Gutierrez, Orlando M.
AU - Hamano, Takayuki
AU - Heine, Gunnar H.
AU - Ishikawa, Shizukiyo
AU - Jee, Sun Ha
AU - Kronenberg, Florian
AU - Landray, Martin J.
AU - Miura, Katsuyuki
AU - Nadkarni, Girish N.
AU - Peralta, Carmen A.
AU - Rothenbacher, Dietrich
AU - Schaeffner, Elke
AU - Sedaghat, Sanaz
AU - Shlipak, Michael G.
AU - Zhang, Luxia
AU - van Zuilen, Arjan D.
AU - Hallan, Stein I.
AU - Kovesdy, Csaba P.
AU - Woodward, Mark
AU - Levin, Adeera
AU - Astor, Brad
AU - Appel, Larry
AU - Greene, Tom
AU - Chen, Teresa
AU - Chalmers, John
AU - Arima, Hisatomi
AU - Perkovic, Vlado
AU - Yatsuya, Hiroshi
AU - Tamakoshi, Koji
AU - Li, Yuanying
AU - Hirakawa, Yoshihisa
AU - Matsushita, Kunihiro
AU - Sang, Yingying
AU - Polkinghorne, Kevan
AU - Chadban, Steven
AU - Atkins, Robert
AU - Djurdjev, Ognjenka
AU - Liu, Lisheng
AU - Zhao, Minghui
AU - Wang, Fang
AU - Wang, Jinwei
AU - Chodick, Gabriel
AU - Shalev, Varda
N1 - Publisher Copyright:
© 2018 National Kidney Foundation, Inc.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Rationale & Objective: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework. Study Design: Cross-sectional individual participant-level analyses in a global consortium. Setting & Study Populations: 17 CKD and 38 general population and high-risk cohorts. Selection Criteria for Studies: Cohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension. Data Extraction: Data were obtained and analyzed between July 2015 and January 2018. Analytical Approach: We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses. Results: The CKD cohorts (n = 254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n = 1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years. There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 [95% CI, 2.68-3.97] to 8.91 [95% CI, 7.22-10.99] comparing eGFRs of 15 to 29 with eGFRs of 45 to 59 mL/min/1.73 m2), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 [95% CI, 0.60-0.99] to 1.92 [95% CI, 1.65-2.24] comparing urinary albumin-creatinine ratio > 300 vs < 30 mg/g). Limitations: Variations in study era, health care delivery system, typical diet, and laboratory assays. Conclusions: Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.
AB - Rationale & Objective: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework. Study Design: Cross-sectional individual participant-level analyses in a global consortium. Setting & Study Populations: 17 CKD and 38 general population and high-risk cohorts. Selection Criteria for Studies: Cohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension. Data Extraction: Data were obtained and analyzed between July 2015 and January 2018. Analytical Approach: We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses. Results: The CKD cohorts (n = 254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n = 1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years. There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 [95% CI, 2.68-3.97] to 8.91 [95% CI, 7.22-10.99] comparing eGFRs of 15 to 29 with eGFRs of 45 to 59 mL/min/1.73 m2), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 [95% CI, 0.60-0.99] to 1.92 [95% CI, 1.65-2.24] comparing urinary albumin-creatinine ratio > 300 vs < 30 mg/g). Limitations: Variations in study era, health care delivery system, typical diet, and laboratory assays. Conclusions: Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.
KW - CKD Prognosis Consortium
KW - CKD stage
KW - Chronic kidney disease (CKD)
KW - albuminuria
KW - anemia
KW - diabetes
KW - glomerular filtration rate (GFR)
KW - hematocrit
KW - hemoglobin
KW - hyperparathyroidism
KW - hypertension
KW - individual-level meta-analysis
KW - kidney function
KW - laboratory abnormality
KW - laboratory tests
KW - meta-analysis
KW - serum bicarbonate
KW - serum calcium
KW - serum intact parathyroid hormone
KW - serum phosphorus
KW - serum potassium
KW - staging system
UR - http://www.scopus.com/inward/record.url?scp=85055052859&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2018.08.013
DO - 10.1053/j.ajkd.2018.08.013
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C2 - 30348535
AN - SCOPUS:85055052859
SN - 0272-6386
VL - 73
SP - 206
EP - 217
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -