Abstract
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. Cross-sectional individual participant-level analyses in a global consortium. 17 CKD and 38 general population and high-risk cohorts. 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 were obtained and analyzed between July 2015 and January2018. 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. 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 59mL/min/1.73m2), 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< 30mg/g). Variations in study era, health care delivery system, typical diet, and laboratory assays. 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.
Highlights
Chronic kidney disease (CKD) is a worldwide public health problem with high risk of kidney failure, cardiovascular disease, and death
Analytic Approach: We modeled the association of eGFR and albuminuria with hemoglobin, bicarbonate, phosphorous, parathyroid hormone, potassium, and calcium using linear regression; and with hypertension and categorical definitions of each abnormality using logistic regression
Lower eGFR was associated with lower levels of hemoglobin and bicarbonate, and higher levels of potassium, parathyroid hormone (PTH), and phosphorus in the CKD cohorts, with similar associations in the general population/high risk cohorts (Figures 1 and 2)
Summary
Chronic kidney disease (CKD) is a worldwide public health problem with high risk of kidney failure, cardiovascular disease, and death. In addition to the long-term risk of adverse events, CKD is complicated by the presence of abnormalities that reflect disruption in the excretory, metabolic, and endocrine functions of the kidney. These abnormalities include anemia, hyperkalemia, acidosis, hyperparathyroidism, hyperphosphatemia, and hypocalcemia as well as hypertension, and often drive further investigations or treatment decisions. In patients with kidney failure, these are often referred to as uremic manifestations, or complications, of kidney disease and are quite common. These abnormalities do not occur in all patients with earlier stages of CKD. Prior studies in general population and CKD cohorts have documented the risk of abnormalities with the level of eGFR or albuminuria,[6,7,8,9] but few have looked comprehensively and concomitantly across the new CKD staging system, which classifies the severity of CKD by eGFR (G) and albuminuria (A) stage.[10, 11] In addition, the consistency of risk associations across diverse global cohorts along a wide range of eGFR, albuminuria, age, and diabetes has not been determined
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