The contribution of chronic kidney disease measures to cause-specific mortality and morbidity

Abstract

Chronic kidney disease (CKD) is increasing common public health problem worldwide. The association of CKD with cardiovascular disease (CVD) mortality is well known, however, the association with other causes mortality such as cancer is unclear. This study assessed the effects of CKD on the cause-specific mortality in a large cohort study.

We studied 367,932 adults (20-93 years old) in the Metabolic Syndrome Mortality Study (health check-up database in Korea with baseline between 1994-2004) and 233,219 adults (30-74 years old) in the Korean Heart Study (baseline between 1996-2004). We assessed the associations of creatinine-based estimated glomerular filtration rate (eGFR) and dipstick proteinuria with mortality and morbidity due to CVD (1,608 cases), cancer (4,035 cases), and non-CVD/cancer (3,152 cases) after adjusting for potential confounders.

Lower eGFR (<60 ml/min/1.73m2 vs. ≥60 ml/min/1.73m2) was significantly associated with mortality due to CVD [hazard ratio (HR), 1.49 (95% CI, 1.24-1.78)] and non-CVD/cancer [1.78 (1.54-2.05)]. Adjusted cancer mortality risk was the lowest at GFR 45-59 and reached significance at eGFR <45 ml/min/1.73m2 [1.62 (1.10-2.39)] with eGFR 45-59 ml/min/1.73m2 as a reference. 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 non-CVD/cancer [2.19 (1.96-2.45)]. Examination on causes of deaths suggested that low eGFR was significantly associated with higher mortality due to coronary diabetes, infectious disease, heart disease, oropharyngeal cancer, and renal failure, whereas proteinuria was related to mortality from coronary diabetes, infectious disease, heart disease, liver disease, myeloma, renal failure, stroke, and cancers of the stomach, liver, pancreas, and lung. When examining for morbidity, the study found a similar relationship with the results of mortality. Also, a rapid decline in eGFR inferred significantly greater risk for CVD mortality.

Low eGFR was mainly associated with CVD and non-CVD/cancer mortality, whereas proteinuria was consistently related to mortality due to CVD, cancer, and non-CVD/cancer. These findings suggest the need for multidisciplinary prevention and management strategies in individuals with CKD.