A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury
Authors
Morgan E. Grams ; Yingying Sang ; Shoshana H. Ballew ; Ron T. Gansevoort ; Heejin Kimm ; Csaba P. Kovesdy ; David Naimark ; Cecilia Oien ; David H. Smith ; Josef Coresh ; Mark J. Sarnak ; Benedicte Stengel ; Marcello Tonelli
Citation
AMERICAN JOURNAL OF KIDNEY DISEASES, Vol.66(4) : 591-601, 2015
Acute Kidney Injury/diagnosis* ; Acute Kidney Injury/epidemiology* ; Adolescent ; Adult ; African Americans/statistics & numerical data ; Age Distribution ; Aged ; Albuminuria/diagnosis ; Albuminuria/epidemiology* ; Continental Population Groups/statistics & numerical data* ; European Continental Ancestry Group/statistics & numerical data ; Female ; Glomerular Filtration Rate/physiology* ; Humans ; Incidence ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Sex Distribution ; Young Adult
Keywords
Chronic Kidney Disease Prognosis Consortium ; Estimated glomerular filtration rate (eGFR) ; acute kidney injury (AKI) ; acute renal failure (ARF) ; age ; albumin-creatinine ratio (ACR) ; albuminuria ; meta-analysis ; proteinuria ; race/ethnicity ; renal function ; sex
Abstract
BACKGROUND: Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white).
SELECTION CRITERIA FOR STUDIES: Available eGFR, ACR, and 50 or more AKI events.
PREDICTORS: Age, sex, race, eGFR, urine ACR, and interactions.
OUTCOME: Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.
RESULTS: 16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR.
LIMITATIONS: Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code.
CONCLUSIONS: Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.