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Review
. 2015 Oct;66(4):602-12.
doi: 10.1053/j.ajkd.2015.02.338. Epub 2015 May 11.

A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury

Matthew T James  1 , Morgan E Grams  2 , Mark Woodward  3 , C Raina Elley  4 , Jamie A Green  5 , David C Wheeler  6 , Paul de Jong  7 , Ron T Gansevoort  7 , Andrew S Levey  8 , David G Warnock  9 , Mark J Sarnak  8 ; CKD Prognosis Consortium
Collaborators, Affiliations
Review

A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury

Matthew T James et al. Am J Kidney Dis. 2015 Oct.

Abstract

Background: Diabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain.

Study design: Meta-analysis of cohort studies.

Setting & population: 8 general-population (1,285,045 participants) and 5 chronic kidney disease (CKD; 79,519 participants) cohorts.

Selection criteria for studies: Cohorts participating in the CKD Prognosis Consortium.

Predictors: Diabetes and hypertension status, eGFR by the 2009 CKD Epidemiology Collaboration creatinine equation, urine ACR, and interactions.

Outcome: Hospitalization with AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.

Results: During a mean follow-up of 4 years, there were 16,480 episodes of AKI in the general-population and 2,087 episodes in the CKD cohorts. Low eGFRs and high ACRs were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR of 80mL/min/1.73m(2) in nondiabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared with nondiabetic patients. The risk gradient for AKI with lower eGFRs was greater in those without diabetes than with diabetes, but similar with higher ACRs in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFRs>60mL/min/1.73m(2) than those without hypertension. However, risk gradients for AKI with both lower eGFRs and higher ACRs were greater for those without than with hypertension.

Limitations: AKI identified by diagnostic code.

Conclusions: Lower eGFRs and higher ACRs are associated with higher risks of AKI among individuals with or without either diabetes or hypertension.

Keywords: Chronic Kidney Disease Prognosis Consortium; Estimated glomerular filtration rate (eGFR); acute kidney injury (AKI); acute renal failure (ARF); albumin-creatine ratio (ACR); albuminuria; diabetes; hypertension; meta-analysis; renal function.

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Conflict of interest statement

Financial disclosures: There are no conflicts

Figures

Figure 1
Figure 1
Hazard ratios (with 95% confidence intervals) of AKI, using common referent groupwithout diabetes, according to eGFR (left, reference eGFR 80 without diabetes) and ACR (right, reference ACR 5 without diabetes) in individuals with and without diabetes in general population cohorts.
Figure 2
Figure 2
Hazard ratios (with 95% confidence intervals) of AKI, using separate reference groups by diabetes status, according to eGFR (left, reference eGFR 80) and ACR (right, reference ACR 5) in individuals with and without diabetes in general population cohorts. Triangles indicate significant (P<0.05) multiplicative pointwise interactions.
Figure 3
Figure 3
Hazard ratios (with 95% confidence intervals) of AKI, using common referent group without diabetes, according to eGFR (left, reference eGFR 50 without diabetes) and ACR (right, reference ACR 50 without diabetes) in individuals with and without diabetes in CKD cohorts.
Figure 4
Figure 4
Hazard ratios (with 95% confidence intervals) of AKI, using separate reference groups by diabetes status, according to eGFR (left, reference eGFR 50) and ACR (right, reference ACR 50) in individuals with and without diabetes in CKD cohorts.
Figure 5
Figure 5
Hazard ratios (with 95% confidence intervals) of AKI, using common referent group without hypertension, according to eGFR (left, reference eGFR 80 without hypertension) and ACR (right, reference ACR 5 without hypertension) in individuals with and without hypertension in general population cohorts.
Figure 6
Figure 6
Hazard ratios (with 95% confidence intervals) of AKI, using seperate reference groups by hypertensive status, according to eGFR (left, reference eGFR 80) and ACR (right, reference ACR 5) in individuals with and without hypertension in general population cohorts.
Figure 7
Figure 7
Hazard ratios (with 95% confidence intervals) of AKI, using common referent group without hypertension, according to eGFR (left, reference eGFR 50 without hypertension) and ACR (right, reference ACR 50 without hypertension) in individuals with and without hypertension in CKD cohorts.
Figure 8
Figure 8
Hazard ratios (with 95% confidence intervals) of AKI, using, separate reference groups by hypertensive status, according to eGFR (left, reference eGFR 50) and ACR (right, reference ACR 50) in individuals with and without hypertension in CKD cohorts.
See this image and copyright information in PMC

Comment in

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