Abstract
BackgroundThe 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.MethodsWe 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.ResultsAlthough 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/1.73m2 and 54.3% for proteinuria ≥1+). Lower eGFR (<60 vs. ≥60 ml/min/1.73m2) 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/1.73m2 when eGFR 45–59 ml/min/1.73m2 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.ConclusionLow 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.
Highlights
Chronic kidney disease (CKD), defined as reduced kidney function and/or kidney damage, is a worldwide public health problem [1,2,3]
Cancer was overall the most common cause of mortality, in participants with chronic kidney disease (CKD), non-Cardiovascular disease (CVD)/non-cancer mortality accounted for approximately half of cause of death (47.0%for estimated glomerular filtration rate (eGFR)
Low eGFR and high proteinuria were commonly associated with mortality due to coronary heart disease, any infectious disease, diabetes, and renal failure
Summary
Chronic kidney disease (CKD), defined as reduced kidney function and/or kidney damage, is a worldwide public health problem [1,2,3]. Numerous studies have reported the significant associations of lower estimated glomerular filtration rate (eGFR) and higher proteinuria with CVD mortality [10, 13,14,15]. Several studies report the associations of these CKD measures with all-cause mortality [7,8,9,10,11]. To our knowledge, the only study to simultaneously investigate both key CKD measures, eGFR and proteinuria [20], did not find a significant association between CKD and cancer mortality [12]. The link of low estimated glomerular filtration rate (eGFR) and high proteinuria to cardiovascular disease (CVD) mortality is well known. Its link to mortality due to other causes is less clear
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