Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium

CKD Prognosis Consortium

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Jan 1 2018

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Albuminuria
Chronic Renal Insufficiency
Meta-Analysis
Glomerular Filtration Rate
Bicarbonates
Hypertension
Parathyroid Hormone
Phosphorus
Potassium
Hemoglobins
Population
Calcium
Delivery of Health Care
Patient Selection
Albumins
Linear Models
Creatinine
Cohort Studies
Cross-Sectional Studies
Logistic Models

Keywords

  • albuminuria
  • anemia
  • Chronic kidney disease (CKD)
  • CKD Prognosis Consortium
  • CKD stage
  • diabetes
  • glomerular filtration rate (GFR)
  • hematocrit
  • hemoglobin
  • hyperparathyroidism
  • hypertension
  • individual-level meta-analysis
  • kidney function
  • laboratory abnormality
  • laboratory tests
  • meta-analysis
  • serum bicarbonate
  • serum calcium
  • serum intact parathyroid hormone
  • serum phosphorus
  • serum potassium
  • staging system

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{9a62ac82f9c04a96aed9ab56dc1c4833,
title = "Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium",
abstract = "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.",
keywords = "albuminuria, anemia, Chronic kidney disease (CKD), CKD Prognosis Consortium, CKD stage, diabetes, glomerular filtration rate (GFR), hematocrit, hemoglobin, hyperparathyroidism, hypertension, individual-level meta-analysis, kidney function, laboratory abnormality, laboratory tests, meta-analysis, serum bicarbonate, serum calcium, serum intact parathyroid hormone, serum phosphorus, serum potassium, staging system",
author = "{CKD Prognosis Consortium} and Inker, {Lesley A.} and Grams, {Morgan E.} and Levey, {Andrew S.} and Josef Coresh and Massimo Cirillo and Collins, {John F.} and Gansevoort, {Ron T.} and Gutierrez, {Orlando M.} and Takayuki Hamano and Heine, {Gunnar H.} and Shizukiyo Ishikawa and Jee, {Sun Ha} and Florian Kronenberg and Landray, {Martin J.} and Katsuyuki Miura and Nadkarni, {Girish N.} and Peralta, {Carmen A.} and Dietrich Rothenbacher and Elke Schaeffner and Sanaz Sedaghat and Shlipak, {Michael G.} and Luxia Zhang and {van Zuilen}, {Arjan D.} and Hallan, {Stein I.} and Kovesdy, {Csaba P.} and Mark Woodward and Adeera Levin and Brad Astor and Larry Appel and Tom Greene and Teresa Chen and John Chalmers and Mark Woodward and Hisatomi Arima and Vlado Perkovic and Hiroshi Yatsuya and Koji Tamakoshi and Yuanying Li and Yoshihisa Hirakawa and Josef Coresh and Kunihiro Matsushita and Morgan Grams and Yingying Sang and Kevan Polkinghorne and Steven Chadban and Robert Atkins and Adeera Levin and Ognjenka Djurdjev and Anna K{\"o}ttgen and Csaba Kovesdy",
year = "2018",
month = "1",
day = "1",
doi = "10.1053/j.ajkd.2018.08.013",
language = "English (US)",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",

}

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 - Woodward, Mark

AU - Arima, Hisatomi

AU - Perkovic, Vlado

AU - Yatsuya, Hiroshi

AU - Tamakoshi, Koji

AU - Li, Yuanying

AU - Hirakawa, Yoshihisa

AU - Coresh, Josef

AU - Matsushita, Kunihiro

AU - Grams, Morgan

AU - Sang, Yingying

AU - Polkinghorne, Kevan

AU - Chadban, Steven

AU - Atkins, Robert

AU - Levin, Adeera

AU - Djurdjev, Ognjenka

AU - Köttgen, Anna

AU - Kovesdy, Csaba

PY - 2018/1/1

Y1 - 2018/1/1

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 - albuminuria

KW - anemia

KW - Chronic kidney disease (CKD)

KW - CKD Prognosis Consortium

KW - CKD stage

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

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U2 - 10.1053/j.ajkd.2018.08.013

DO - 10.1053/j.ajkd.2018.08.013

M3 - Article

C2 - 30348535

AN - SCOPUS:85055052859

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

ER -