Lesley A. Inker, Morgan E. Grams, Andrew S. Levey, Josef Coresh, Massimo Cirillo, John F. Collins, Ron T. Gansevoort, Orlando M. Gutierrez, Takayuki Hamano, Gunnar H. Heine, Shizukiyo Ishikawa, Sun Ha Jee, Florian Kronenberg, Martin J. Landray, Katsuyuki Miura, Girish N. Nadkarni, Carmen A. Peralta, Dietrich Rothenbacher, Elke Schaeffner, Sanaz Sedaghat, Michael G. Shlipak, Luxia Zhang, Arjan D. van Zuilen, Stein I. Hallan, Csaba P. Kovesdy, Mark Woodward, Adeera Levin, Brad Astor, Larry Appel, Tom Greene, Teresa Chen, John Chalmers, Hisatomi Arima, Vlado Perkovic, Hiroshi Yatsuya, Koji Tamakoshi, Yuanying Li, Yoshihisa Hirakawa, Kunihiro Matsushita, Yingying Sang, Kevan Polkinghorne, Steven Chadban, Robert Atkins, Ognjenka Djurdjev, Lisheng Liu, Minghui Zhao, Fang Wang, Jinwei Wang, Natalie Ebert, Peter Martus, Mila Tang, Insa Emrich, Sarah Seiler, Adam Zawada, Joseph Nally, Sankar Navaneethan, Jesse Schold, Mark Sarnak, Ronit Katz, Jade Hiramoto, Hiroyasu Iso, Kazumasa Yamagishi, Mitsumasa Umesawa, Isao Muraki, Masafumi Fukagawa, Shoichi Maruyama, Takeshi Hasegawa, Naohiko Fujii, David Wheeler, John Emberson, John Townend, Hermann Brenner, Ben Schöttker, Kai Uwe Saum, Caroline Fox, Shih Jen Hwang, Anna Köttgen, Markus P. Schneider, Kai Uwe Eckardt, Jamie Green, H. Lester Kirchner, Alex R. Chang, Kevin Ho, Sadayoshi Ito, Mariko Miyazaki, Masaaki Nakayama, Gen Yamada, Fujiko Irie, Toshimi Sairenchi, Yuichiro Yano, Kazuhiko Kotani, Takeshi Nakamura, Heejin Kimm, Yejin Mok, Gabriel Chodick, Varda Shalev, Jack F.M. Wetzels, Peter J. Blankestijn, Jan van den Brand, Barbara Kollerits
American Journal of Kidney Diseases 73 2 206 - 217 2019年02月
© 2018 National Kidney Foundation, Inc. Rationale & Objective: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework. Study Design: Cross-sectional individual participant-level analyses in a global consortium. Setting & Study Populations: 17 CKD and 38 general population and high-risk cohorts. Selection Criteria for Studies: Cohorts in the CKD Prognosis Consortium with data for eGFR and albuminuria, as well as a measurement of hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, or calcium, or hypertension. Data Extraction: Data were obtained and analyzed between July 2015 and January 2018. Analytical Approach: We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorus, parathyroid hormone, potassium, and calcium values using linear regression and with hypertension and categorical definitions of each abnormality using logistic regression. Results were pooled using random-effects meta-analyses. Results: The CKD cohorts (n = 254,666 participants) were 27% women and 10% black, with a mean age of 69 (SD, 12) years. The general population/high-risk cohorts (n = 1,758,334) were 50% women and 2% black, with a mean age of 50 (16) years. There was a strong graded association between lower eGFR and all laboratory result abnormalities (ORs ranging from 3.27 [95% CI, 2.68-3.97] to 8.91 [95% CI, 7.22-10.99] comparing eGFRs of 15 to 29 with eGFRs of 45 to 59 mL/min/1.73 m2), whereas albuminuria had equivocal or weak associations with abnormalities (ORs ranging from 0.77 [95% CI, 0.60-0.99] to 1.92 [95% CI, 1.65-2.24] comparing urinary albumin-creatinine ratio > 300 vs < 30 mg/g). Limitations: Variations in study era, health care delivery system, typical diet, and laboratory assays. Conclusions: Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.