Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: A meta-analysis

Dorothea Nitsch, Morgan Grams, Yingying Sang, Corri Black, Massimo Cirillo, Ognjenka Djurdjev, Kunitoshi Iseki, Simerjot K. Jassal, Heejin Kimm, Florian Kronenberg, Cecilia M. Øien, Andrew S. Levey, Adeera Levin, Mark Woodward, Brenda R. Hemmelgarn

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. Design: Random effects meta-analysis using pooled individual participant data. Setting: 46 cohorts from Europe, North and South America, Asia, and Australasia. Participants 2 051 158 participants (54% women) from general population cohorts (n=1 861 052), high risk cohorts (n=151 494), and chronic kidney disease cohorts (n=38 612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m2) and urinary albumin-creatinine ratio (mg/g). Results: Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (Pinteraction<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (Pinteraction<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk. Conclusions Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.

Original languageEnglish (US)
Article numberA19
JournalBMJ (Online)
Volume346
Issue number7895
DOIs
StatePublished - Feb 16 2013

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: A meta-analysis'. Together they form a unique fingerprint.

Cite this