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

CKD Prognosis Consortium

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2 Citations (Scopus)

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
Pages (from-to)206-217
Number of pages12
JournalAmerican Journal of Kidney Diseases
Volume73
Issue number2
DOIs
Publication statusPublished - 01-02-2019

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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

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

@article{106c110689c441a5a12a79b57646bebf,
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.",
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 Hisatomi Arima and Vlado Perkovic and Hiroshi Yatsuya and Koji Tamakoshi and Yuanying Li and Hiroshi Yatsuya and Kunihiro Matsushita and Enei Ri and Kevan Polkinghorne and Steven Chadban and Robert Atkins and Ognjenka Djurdjev and Lisheng Liu and Minghui Zhao and Fang Wang and Jinwei Wang and Natalie Ebert and Peter Martus",
year = "2019",
month = "2",
day = "1",
doi = "10.1053/j.ajkd.2018.08.013",
language = "English",
volume = "73",
pages = "206--217",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "2",

}

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 - Yatsuya, Hiroshi

AU - Matsushita, Kunihiro

AU - Ri, Enei

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 - Ebert, Natalie

AU - Martus, Peter

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.

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U2 - 10.1053/j.ajkd.2018.08.013

DO - 10.1053/j.ajkd.2018.08.013

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VL - 73

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EP - 217

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

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