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Association of Kidney Disease Measures with Cause-Specific Mortality: The Korean Heart Study.

Mok Y, Matsushita K, Sang Y, Ballew SH, Grams M, Shin SY, Jee SH, Coresh J - PLoS ONE (2016)

Bottom Line: However, its link to mortality due to other causes is less clear.In addition, proteinuria was also related to death from stroke, cancers of stomach, liver, pancreas, and lung, myeloma, pneumonia, and viral hepatitis.These findings suggest the need for multidisciplinary prevention and management strategies in individuals with CKD, particularly when proteinuria is present.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.

ABSTRACT

Background: The link of low estimated glomerular filtration rate (eGFR) and high proteinuria to cardiovascular disease (CVD) mortality is well known. However, its link to mortality due to other causes is less clear.

Methods: We studied 367,932 adults (20-93 years old) in the Korean Heart Study (baseline between 1996-2004 and follow-up until 2011) and assessed the associations of creatinine-based eGFR and dipstick proteinuria with mortality due to CVD (1,608 cases), cancer (4,035 cases), and other (non-CVD/non-cancer) causes (3,152 cases) after adjusting for potential confounders.

Results: Although cancer was overall the most common cause of mortality, in participants with chronic kidney disease (CKD), non-CVD/non-cancer mortality accounted for approximately half of cause of death (47.0%for eGFR <60 ml/min/1.73 m2 and 54.3% for proteinuria ≥1+). Lower eGFR (<60 vs. ≥60 ml/min/1.73 m2) was significantly associated with mortality due to CVD (adjusted hazard ratio 1.49 [95% CI, 1.24-1.78]) and non-CVD/non-cancer causes (1.78 [1.54-2.05]). The risk of cancer mortality only reached significance at eGFR <45 ml/min/1.73 m2 when eGFR 45-59 ml/min/1.73 m2 was set as a reference (1.62 [1.10-2.39]). High proteinuria (dipstick ≥1+ vs. negative/trace) was consistently associated with mortality due to CVD (1.93 [1.66-2.25]), cancer (1.49 [1.32-1.68]), and other causes (2.19 [1.96-2.45]). Examining finer mortality causes, low eGFR and high proteinuria were commonly associated with mortality due to coronary heart disease, any infectious disease, diabetes, and renal failure. In addition, proteinuria was also related to death from stroke, cancers of stomach, liver, pancreas, and lung, myeloma, pneumonia, and viral hepatitis.

Conclusion: Low eGFR was associated with CVD and non-CVD/non-cancer mortality, whereas higher proteinuria was consistently related to mortality due to CVD, cancer, and other causes. These findings suggest the need for multidisciplinary prevention and management strategies in individuals with CKD, particularly when proteinuria is present.

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Adjusted hazard ratios of cause-specific mortality for eGFR<60 ml/min/1.73m2 (vs.≥60).
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pone.0153429.g003: Adjusted hazard ratios of cause-specific mortality for eGFR<60 ml/min/1.73m2 (vs.≥60).

Mentions: Examining finer mortality causes, low eGFR (<60 vs. ≥60 ml/min/1.73m2) and high proteinuria (≥1+ vs. none/trace) were both associated with increased risk of death from coronary disease, any infectious diseases, diabetes, and renal failure (Figs 3 and 4). In addition, low eGFR was significantly associated with increased risk of death from oropharyngeal cancer as well as paradoxically with decreased risk of death from lung cancer and liver disease (Fig 3). Proteinuria demonstrated significant associations with broader mortality causes compared to eGFR such as stroke, cancer of various organs (i.e., stomach, liver, pancreas, lung, urinary tract), myeloma, and liver disease (Fig 4). For liver outcomes, when we further adjusted for alcohol intake, liver enzymes, and seropositivity to hepatitis B and C viruses, the association remained significant for mortality from liver cancer and viral hepatitis (1.41 [1.03–1.94] and 4.06 [1.76–9.39], respectively) but not for mortality from other types of liver disease (1.38 [0.79–2.38]). Largely consistent results were observed when we excluded deaths in the first three years of follow-up (S1 and S2 Figs).


Association of Kidney Disease Measures with Cause-Specific Mortality: The Korean Heart Study.

Mok Y, Matsushita K, Sang Y, Ballew SH, Grams M, Shin SY, Jee SH, Coresh J - PLoS ONE (2016)

Adjusted hazard ratios of cause-specific mortality for eGFR<60 ml/min/1.73m2 (vs.≥60).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836674&req=5

pone.0153429.g003: Adjusted hazard ratios of cause-specific mortality for eGFR<60 ml/min/1.73m2 (vs.≥60).
Mentions: Examining finer mortality causes, low eGFR (<60 vs. ≥60 ml/min/1.73m2) and high proteinuria (≥1+ vs. none/trace) were both associated with increased risk of death from coronary disease, any infectious diseases, diabetes, and renal failure (Figs 3 and 4). In addition, low eGFR was significantly associated with increased risk of death from oropharyngeal cancer as well as paradoxically with decreased risk of death from lung cancer and liver disease (Fig 3). Proteinuria demonstrated significant associations with broader mortality causes compared to eGFR such as stroke, cancer of various organs (i.e., stomach, liver, pancreas, lung, urinary tract), myeloma, and liver disease (Fig 4). For liver outcomes, when we further adjusted for alcohol intake, liver enzymes, and seropositivity to hepatitis B and C viruses, the association remained significant for mortality from liver cancer and viral hepatitis (1.41 [1.03–1.94] and 4.06 [1.76–9.39], respectively) but not for mortality from other types of liver disease (1.38 [0.79–2.38]). Largely consistent results were observed when we excluded deaths in the first three years of follow-up (S1 and S2 Figs).

Bottom Line: However, its link to mortality due to other causes is less clear.In addition, proteinuria was also related to death from stroke, cancers of stomach, liver, pancreas, and lung, myeloma, pneumonia, and viral hepatitis.These findings suggest the need for multidisciplinary prevention and management strategies in individuals with CKD, particularly when proteinuria is present.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.

ABSTRACT

Background: The link of low estimated glomerular filtration rate (eGFR) and high proteinuria to cardiovascular disease (CVD) mortality is well known. However, its link to mortality due to other causes is less clear.

Methods: We studied 367,932 adults (20-93 years old) in the Korean Heart Study (baseline between 1996-2004 and follow-up until 2011) and assessed the associations of creatinine-based eGFR and dipstick proteinuria with mortality due to CVD (1,608 cases), cancer (4,035 cases), and other (non-CVD/non-cancer) causes (3,152 cases) after adjusting for potential confounders.

Results: Although cancer was overall the most common cause of mortality, in participants with chronic kidney disease (CKD), non-CVD/non-cancer mortality accounted for approximately half of cause of death (47.0%for eGFR <60 ml/min/1.73 m2 and 54.3% for proteinuria ≥1+). Lower eGFR (<60 vs. ≥60 ml/min/1.73 m2) was significantly associated with mortality due to CVD (adjusted hazard ratio 1.49 [95% CI, 1.24-1.78]) and non-CVD/non-cancer causes (1.78 [1.54-2.05]). The risk of cancer mortality only reached significance at eGFR <45 ml/min/1.73 m2 when eGFR 45-59 ml/min/1.73 m2 was set as a reference (1.62 [1.10-2.39]). High proteinuria (dipstick ≥1+ vs. negative/trace) was consistently associated with mortality due to CVD (1.93 [1.66-2.25]), cancer (1.49 [1.32-1.68]), and other causes (2.19 [1.96-2.45]). Examining finer mortality causes, low eGFR and high proteinuria were commonly associated with mortality due to coronary heart disease, any infectious disease, diabetes, and renal failure. In addition, proteinuria was also related to death from stroke, cancers of stomach, liver, pancreas, and lung, myeloma, pneumonia, and viral hepatitis.

Conclusion: Low eGFR was associated with CVD and non-CVD/non-cancer mortality, whereas higher proteinuria was consistently related to mortality due to CVD, cancer, and other causes. These findings suggest the need for multidisciplinary prevention and management strategies in individuals with CKD, particularly when proteinuria is present.

Show MeSH
Related in: MedlinePlus