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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 all-cause mortality.
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pone-0025920-g004: Meta-analysis of the association between eGFR and all-cause mortality.

Mentions: In studies among people without prior vascular disease, a 30% lower eGFR level was, on average across the range studied, associated with a 31% increase in the risk of death from any cause (RR 1.31 [95% CI 1.31 to 1.32: Figure 4). The estimated RR per 30% lower eGFR was comparable across the different study designs (1.26 [95% CI 1.24 to 1.28] in prospective cohort studies, 1.32 [95% CI 1.31 to 1.32] in retrospective cohort studies and 1.29 [95% CI 1.17 to 1.42] in randomised controlled trials). Within the prospective and retrospective cohort studies, however, there was substantial heterogeneity between the results from the individual studies (Figure 4). In studies of individuals with prior vascular disease a 30% lower eGFR was associated with 23% increase in the risk of death from any cause (RR 1.23 [95% CI 1.22 to 1.23]: figure 4). A slightly higher relative risk was observed in prospective cohort studies (1.36 [95% CI 1.30 to 1.41]) than in the retrospective cohort studies (1.22 [95% CI 1.22 to 1.23]) or the randomised controlled trials (1.23 [95% CI 1.20 to 1.26]). Substantial heterogeneity was observed between the results from the different prospective and retrospective cohort studies, but not between the results from the trials (Figure 4). Among the 50 studies assessing all cause mortality in people with prior vascular disease, 24 included individuals who were acutely unwell at baseline (Table S1). Results were similar when these studies were excluded (RR per 30% lower eGFR 1.24 [95 CI 1.24–1.25]).


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 all-cause mortality.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0025920-g004: Meta-analysis of the association between eGFR and all-cause mortality.
Mentions: In studies among people without prior vascular disease, a 30% lower eGFR level was, on average across the range studied, associated with a 31% increase in the risk of death from any cause (RR 1.31 [95% CI 1.31 to 1.32: Figure 4). The estimated RR per 30% lower eGFR was comparable across the different study designs (1.26 [95% CI 1.24 to 1.28] in prospective cohort studies, 1.32 [95% CI 1.31 to 1.32] in retrospective cohort studies and 1.29 [95% CI 1.17 to 1.42] in randomised controlled trials). Within the prospective and retrospective cohort studies, however, there was substantial heterogeneity between the results from the individual studies (Figure 4). In studies of individuals with prior vascular disease a 30% lower eGFR was associated with 23% increase in the risk of death from any cause (RR 1.23 [95% CI 1.22 to 1.23]: figure 4). A slightly higher relative risk was observed in prospective cohort studies (1.36 [95% CI 1.30 to 1.41]) than in the retrospective cohort studies (1.22 [95% CI 1.22 to 1.23]) or the randomised controlled trials (1.23 [95% CI 1.20 to 1.26]). Substantial heterogeneity was observed between the results from the different prospective and retrospective cohort studies, but not between the results from the trials (Figure 4). Among the 50 studies assessing all cause mortality in people with prior vascular disease, 24 included individuals who were acutely unwell at baseline (Table S1). Results were similar when these studies were excluded (RR per 30% lower eGFR 1.24 [95 CI 1.24–1.25]).

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