Chronic kidney disease is characterised by low estimated glomerular filtration rate
(eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these
risks are modified by diabetes is unknown.
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 end-stage renal disease (ESRD) associated with eGFR and albuminuria
in individuals with and without diabetes.
We analysed data for 1,024,977 participants (128,505 with diabetes) from 30 general
population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts.
In the combined general population and high-risk cohorts with data for all-cause mortality,
75,306 deaths occurred during a mean follow-up of 8·5 years (SD 5·0). In the 23 studies
with data for cardiovascular mortality, 21,237 deaths occurred from cardiovascular
disease during a mean follow-up of 9·2 years (SD 4·9). In the general and high-risk
cohorts, mortality risks were 1·2-1·9 times higher for participants with diabetes
than for those without diabetes across the ranges of eGFR and albumin-to-creatinine
ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes
groups, HR of mortality outcomes according to lower eGFR and higher ACR were much
the same in participants with and without diabetes (eg, for all-cause mortality at
eGFR 45 mL/min per 1·73 m(2) [vs 95 mL/min per 1·73 m(2)], HR 1·35; 95% CI 1·18-1·55;
vs 1·33; 1·19-1·48 and at ACR 30 mg/g [vs 5 mg/g], 1·50; 1·35-1·65 vs 1·52; 1·38-1·67).
The overall interactions were not significant. We identified much the same findings
for ESRD in the chronic kidney disease cohorts.
Despite higher risks for mortality and ESRD in diabetes, the relative risks of these
outcomes by eGFR and ACR are much the same irrespective of the presence or absence
of diabetes, emphasising the importance of kidney disease as a predictor of clinical
outcomes.
US National Kidney Foundation.
Copyright © 2012 Elsevier Ltd. All rights reserved.