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A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury

 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 
 AMERICAN JOURNAL OF KIDNEY DISEASES, Vol.66(4) : 591-601, 2015 
Journal Title
Issue Date
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
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
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). STUDY DESIGN: Collaborative meta-analysis. SETTING & POPULATION: 8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants). 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.
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Yonsei Authors
Kimm, Heejin(김희진) ORCID logo https://orcid.org/0000-0003-4526-0570
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