Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: A meta-analysis

Bakhtawar K. Mahmoodi, Kunihiro Matsushita, Mark Woodward, Peter J. Blankestijn, Massimo Cirillo, Takayoshi Ohkubo, Peter Rossing, Mark J. Sarnak, Bénédicte Stengel, Kazumasa Yamagishi, Kentaro Yamashita, Luxia Zhang, Josef Coresh, Paul E. De Jong, Brad C. Astor

Research output: Contribution to journalArticlepeer-review


Background Hypertension is the most prevalent comorbidity in individuals with chronic kidney disease. However, whether the association of the kidney disease measures, estimated glomerular fi ltration rate (eGFR) and albuminuria, with mortality or end-stage renal disease (ESRD) diff ers by hypertensive status is unknown. Methods We did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and ESRD associated with eGFR and albuminuria in individuals with and without hypertension. Findings We analysed data for 45 cohorts (25 general population, seven high-risk, and 13 chronic kidney disease) with 1 127 656 participants, 364 344 of whom had hypertension. Low eGFR and high albuminuria were associated with mortality irrespective of hypertensive status in the general population and high-risk cohorts. All-cause mortality risk was 1•1-1•2 times higher in individuals with hypertension than in those without hypertension at preserved eGFR. A steeper relative risk gradient in individuals without hypertension than in those with hypertension at eGFR range 45-75 mL/min per 1•73 m 2 led to much the same mortality risk at lower eGFR. With a reference eGFR of 95 mL/min per 1•73 m2 in each group to explicitly assess interaction, adjusted HR for all-cause mortality at eGFR 45 mL/min per 1•73 m2 was 1•77 (95% CI 1•57-1•99) in individuals without hypertension versus 1•24 (1•11-1•39) in those with hypertension (p for overall interaction=0•0003). Similarly, for albumin-creatinine ratio of 300 mg/g (vs 5 mg/g), HR was 2•30 (1•98-2•68) in individuals without hypertension versus 2•08 (1•84-2•35) in those with hypertension (p for overall interaction=0•019). We recorded much the same results for cardiovascular mortality. The associations of eGFR and albuminuria with ESRD, however, did not diff er by hypertensive status. Results for chronic kidney disease cohorts were similar to those for general and high-risk population cohorts.

Original languageEnglish (US)
Pages (from-to)1649-1661
Number of pages13
JournalThe Lancet
Issue number9854
StatePublished - Nov 2012

ASJC Scopus subject areas

  • Medicine(all)


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