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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

Meta-analysis of the association between eGFR and major vascular events.
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pone-0025920-g003: Meta-analysis of the association between eGFR and major vascular events.

Mentions: In studies among people without prior vascular disease, each 30% lower eGFR level was associated with a 29% increase in the risk of a MVE (RR 1.29 [95% CI 1.28 to 1.30]: Figure 3). Similar estimates were obtained from the prospective cohort studies (RR 1.31 [95% CI 1.28 to 1.34]) and retrospective cohort studies (RR1.29 [95% CI 1.29 to 1.30]) but the randomised controlled trials yielded a slightly lower relative risk per 30% lower eGFR (RR 1.19 [95%CI 1.15 to 1.23]). There was substantial heterogeneity between the results of the different prospective cohort studies and randomised trials (Figure 3). The relative strength of the relationship between lower eGFR and risk of a MVE was similar among people with prior vascular disease (RR 1.26 [95% CI 1.23 to 1.28] per 30% lower eGFR: Figure 3). As in populations without vascular disease, the results were not substantially different in the different types of study examined (RR per 30% lower eGFR: 1.25 [95% CI 1.18 to 1.32] in prospective cohort studies, 1.34 [95% CI 1.30 to 1.38] in retrospective cohort studies and 1.20 [95% CI 1.17 to 1.23] in randomised controlled trials: Figure 3). There was significant heterogeneity between the results of the individual prospective cohort studies and individual retrospective cohort studies. In contrast, there was no significant heterogeneity between the results of the different randomised trials (Figure 3). Eight of the 26 studies assessing MVEs among people with known prior vascular disease included individuals with an acute illness requiring hospitalisation at baseline (Table S1)). Excluding these studies did not materially alter the results (RR per 30% lower eGFR 1.28 [95% CI 1.25–1.31]).


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)

Meta-analysis of the association between eGFR and major vascular events.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0025920-g003: Meta-analysis of the association between eGFR and major vascular events.
Mentions: In studies among people without prior vascular disease, each 30% lower eGFR level was associated with a 29% increase in the risk of a MVE (RR 1.29 [95% CI 1.28 to 1.30]: Figure 3). Similar estimates were obtained from the prospective cohort studies (RR 1.31 [95% CI 1.28 to 1.34]) and retrospective cohort studies (RR1.29 [95% CI 1.29 to 1.30]) but the randomised controlled trials yielded a slightly lower relative risk per 30% lower eGFR (RR 1.19 [95%CI 1.15 to 1.23]). There was substantial heterogeneity between the results of the different prospective cohort studies and randomised trials (Figure 3). The relative strength of the relationship between lower eGFR and risk of a MVE was similar among people with prior vascular disease (RR 1.26 [95% CI 1.23 to 1.28] per 30% lower eGFR: Figure 3). As in populations without vascular disease, the results were not substantially different in the different types of study examined (RR per 30% lower eGFR: 1.25 [95% CI 1.18 to 1.32] in prospective cohort studies, 1.34 [95% CI 1.30 to 1.38] in retrospective cohort studies and 1.20 [95% CI 1.17 to 1.23] in randomised controlled trials: Figure 3). There was significant heterogeneity between the results of the individual prospective cohort studies and individual retrospective cohort studies. In contrast, there was no significant heterogeneity between the results of the different randomised trials (Figure 3). Eight of the 26 studies assessing MVEs among people with known prior vascular disease included individuals with an acute illness requiring hospitalisation at baseline (Table S1)). Excluding these studies did not materially alter the results (RR per 30% lower eGFR 1.28 [95% CI 1.25–1.31]).

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