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Estimated glomerular filtration rate and the risk of major vascular events and all-cause mortality: a meta-analysis.

Mafham M, Emberson J, Landray MJ, Wen CP, Baigent C - PLoS ONE (2011)

Bottom Line: We used a novel method to summarise the published results.While there was substantial statistical heterogeneity between the results of individual studies, a 30% lower eGFR was consistently associated with a 20-30% higher risk of both outcomes, irrespective of prior history of vascular disease or study design.If these relationships are causal and continuous, then around one fifth of vascular events among those over 70 years might be attributable to renal impairment.

View Article: PubMed Central - PubMed

Affiliation: Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom.

ABSTRACT

Background: Lower estimated glomerular filtration rate (eGFR) has been associated with an increased risk of major vascular events (MVEs) and death, but differences in methodology make between-study comparisons difficult. We used a novel method to summarise the published results.

Methods and findings: Studies assessing the relationship between baseline eGFR and subsequent MVEs or all cause mortality were identified using Pubmed. Those which involved at least 500 individuals, planned at least 1 year of follow-up, reported age and sex adjusted relative risks, and provided the mean eGFR in each category (or sufficient information to allow its estimation) were included. To take account of differences in underlying risk between studies, proportional within-study differences in eGFR (rather than absolute eGFR values) were related to risk. Fifty studies (2 million participants) assessing MVEs and 67 studies (5 million participants) assessing all cause mortality were eligible. There was an inverse relationship between lower eGFR and the risk of MVEs and of death. In studies among people without prior vascular disease, a 30% lower eGFR level was on average associated with a 29% (SE 0.2%) increase in the risk of a MVE and a 31% (SE 0.2%) increase in the risk of death from any cause. In studies among people with prior vascular disease, these estimates were 26% (SE 1.0%) and 23% (SE 0.2%) respectively. While there was substantial statistical heterogeneity between the results of individual studies, a 30% lower eGFR was consistently associated with a 20-30% higher risk of both outcomes, irrespective of prior history of vascular disease or study design.

Conclusions: Lower eGFR was consistently associated with a moderate increase in the risk of death and MVEs. If these relationships are causal and continuous, then around one fifth of vascular events among those over 70 years might be attributable to renal impairment.

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Related in: MedlinePlus

Results of the literature search.
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Related In: Results  -  Collection


getmorefigures.php?uid=PMC3198450&req=5

pone-0025920-g001: Results of the literature search.

Mentions: Figure 1 summarizes the search retrieval process. Out of 11981 abstracts reviewed, 198 papers were retrieved for further examination, of which 80 met the inclusion criteria, with 5 more being identified from the reference lists. Contained within these 85 manuscripts was information relating to 90 different studies. Mean eGFRs in different risk categories were presented (or sufficient information was provided to allow their estimation) in 81 of these studies (58 cohort studies [28 prospective and 30 retrospective] and 23 randomised controlled trials (Table S1).


Estimated glomerular filtration rate and the risk of major vascular events and all-cause mortality: a meta-analysis.

Mafham M, Emberson J, Landray MJ, Wen CP, Baigent C - PLoS ONE (2011)

Results of the literature search.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3198450&req=5

pone-0025920-g001: Results of the literature search.
Mentions: Figure 1 summarizes the search retrieval process. Out of 11981 abstracts reviewed, 198 papers were retrieved for further examination, of which 80 met the inclusion criteria, with 5 more being identified from the reference lists. Contained within these 85 manuscripts was information relating to 90 different studies. Mean eGFRs in different risk categories were presented (or sufficient information was provided to allow their estimation) in 81 of these studies (58 cohort studies [28 prospective and 30 retrospective] and 23 randomised controlled trials (Table S1).

Bottom Line: We used a novel method to summarise the published results.While there was substantial statistical heterogeneity between the results of individual studies, a 30% lower eGFR was consistently associated with a 20-30% higher risk of both outcomes, irrespective of prior history of vascular disease or study design.If these relationships are causal and continuous, then around one fifth of vascular events among those over 70 years might be attributable to renal impairment.

View Article: PubMed Central - PubMed

Affiliation: Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom.

ABSTRACT

Background: Lower estimated glomerular filtration rate (eGFR) has been associated with an increased risk of major vascular events (MVEs) and death, but differences in methodology make between-study comparisons difficult. We used a novel method to summarise the published results.

Methods and findings: Studies assessing the relationship between baseline eGFR and subsequent MVEs or all cause mortality were identified using Pubmed. Those which involved at least 500 individuals, planned at least 1 year of follow-up, reported age and sex adjusted relative risks, and provided the mean eGFR in each category (or sufficient information to allow its estimation) were included. To take account of differences in underlying risk between studies, proportional within-study differences in eGFR (rather than absolute eGFR values) were related to risk. Fifty studies (2 million participants) assessing MVEs and 67 studies (5 million participants) assessing all cause mortality were eligible. There was an inverse relationship between lower eGFR and the risk of MVEs and of death. In studies among people without prior vascular disease, a 30% lower eGFR level was on average associated with a 29% (SE 0.2%) increase in the risk of a MVE and a 31% (SE 0.2%) increase in the risk of death from any cause. In studies among people with prior vascular disease, these estimates were 26% (SE 1.0%) and 23% (SE 0.2%) respectively. While there was substantial statistical heterogeneity between the results of individual studies, a 30% lower eGFR was consistently associated with a 20-30% higher risk of both outcomes, irrespective of prior history of vascular disease or study design.

Conclusions: Lower eGFR was consistently associated with a moderate increase in the risk of death and MVEs. If these relationships are causal and continuous, then around one fifth of vascular events among those over 70 years might be attributable to renal impairment.

Show MeSH
Related in: MedlinePlus