Division of Precision Medicine, Department of Medicine, Grossman School of Medicine, New York University, New York, New York.
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
JAMA. 2023 Oct 3;330(13):1266-1277. doi: 10.1001/jama.2023.17002.
Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US.
To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021.
The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR).
The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses.
Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]).
In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.
慢性肾脏病（估算肾小球滤过率[eGFR]低或白蛋白尿）影响了美国约 14%的成年人。
评估单独基于肌酐的较低 eGFR、基于肌酐和胱抑素 C 的较低 eGFR 以及更严重的白蛋白尿与不良肾脏结局、心血管结局和其他健康结局的相关性。
设计、地点和参与者：个体参与者数据荟萃分析，涉及来自 114 个全球队列的 27503140 人（单独基于肌酐的 eGFR）和来自 20 个队列的 720736 人（基于肌酐和胱抑素 C 的 eGFR）以及来自 1980 年至 2021 年的 114 个队列的 9067753 人（白蛋白尿）。
慢性肾脏病流行病学合作 2021 年基于肌酐的 eGFR 方程和基于肌酐和胱抑素 C 的 eGFR 方程；以及尿白蛋白与肌酐的比值（UACR）估计的白蛋白尿。
需要替代治疗的肾衰竭、全因死亡率、心血管死亡率、急性肾损伤、任何住院、冠心病、中风、心力衰竭、心房颤动和外周动脉疾病的风险。在每个队列内进行了分析，并使用随机效应荟萃分析进行了总结。
在使用单独基于肌酐的 eGFR 的人群中（平均年龄 54 岁[标准差 17 岁]；51%为女性；平均随访时间 4.8 年[标准差 3.3 年]），平均 eGFR 为 90mL/min/1.73m2（标准差 22mL/min/1.73m2），中位数 UACR 为 11mg/g（IQR 8-16mg/g）。在使用基于肌酐和胱抑素 C 的 eGFR 的人群中（平均年龄 59 岁[标准差 12 岁]；53%为女性；平均随访时间 10.8 年[标准差 4.1 年]），平均 eGFR 为 88mL/min/1.73m2（标准差 22mL/min/1.73m2），中位数 UACR 为 9mg/g（IQR 6-18mg/g）。较低的 eGFR（无论是基于肌酐还是基于肌酐和胱抑素 C）和较高的 UACR 均与十种不良结局的风险显著相关，包括慢性肾脏病最轻微的类别。例如，在 UACR 小于 10mg/g 的人群中，与 eGFR 为 90-104mL/min/1.73m2 相比，基于肌酐的 eGFR 为 45-59mL/min/1.73m2 与更高的住院率显著相关（调整后的危险比，1.3[95%CI，1.2-1.3]；每 1000 人年发生 161 例与 79 例事件；每 1000 人年的绝对超额风险，22 例事件[95%CI，每 1000 人年 19-25 例事件]）。
在这项对 114 个队列的回顾性分析中，单独基于肌酐的较低 eGFR、基于肌酐和胱抑素 C 的较低 eGFR 以及更严重的 UACR 均与十种不良结局（包括肾脏不良结局、心血管疾病和住院）的发生率增加相关。
