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. 2017 Jul;28(7):2167-2179.
doi: 10.1681/ASN.2016050562. Epub 2017 Apr 13.

Global Cardiovascular and Renal Outcomes of Reduced GFR

Bernadette Thomas  1   2 , Kunihiro Matsushita  3 , Kalkidan Hassen Abate  4 , Ziyad Al-Aly  5 , Johan Ärnlöv  6   7 , Kei Asayama  8 , Robert Atkins  9 , Alaa Badawi  10   11 , Shoshana H Ballew  3 , Amitava Banerjee  12 , Lars Barregård  13 , Elizabeth Barrett-Connor  14 , Sanjay Basu  15 , Aminu K Bello  16 , Isabela Bensenor  17 , Jaclyn Bergstrom  14 , Boris Bikbov  18 , Christopher Blosser  2 , Hermann Brenner  19 , Juan-Jesus Carrero  20 , Steve Chadban  21   22   23 , Massimo Cirillo  24 , Monica Cortinovis  25 , Karen Courville  25 , Lalit Dandona  26   27 , Rakhi Dandona  26   27 , Kara Estep  26 , João Fernandes  28 , Florian Fischer  29 , Caroline Fox  30 , Ron T Gansevoort  31 , Philimon N Gona  32 , Orlando M Gutierrez  33 , Samer Hamidi  34 , Sarah Wulf Hanson  26 , Jonathan Himmelfarb  2 , Simerjot K Jassal  35 , Sun Ha Jee  36 , Vivekanand Jha  37   38 , Aida Jimenez-Corona  39   40 , Jost B Jonas  41 , Andre Pascal Kengne  42   43 , Yousef Khader  44 , Young-Ho Khang  45 , Yun Jin Kim  46 , Barbara Klein  47 , Ronald Klein  47 , Yoshihiro Kokubo  48 , Dhaval Kolte  49 , Kristine Lee  50 , Andrew S Levey  51 , Yongmei Li  52 , Paulo Lotufo  17 , Hassan Magdy Abd El Razek  53 , Walter Mendoza  54 , Hirohito Metoki  55 , Yejin Mok  36 , Isao Muraki  56 , Paul M Muntner  57 , Hiroyuki Noda  58 , Takayoshi Ohkubo  8 , Alberto Ortiz  59 , Norberto Perico  25 , Kevan Polkinghorne  60   61 , Rajaa Al-Radaddi  62 , Giuseppe Remuzzi  25   63   64 , Gregory Roth  26 , Dietrich Rothenbacher  65 , Michihiro Satoh  55 , Kai-Uwe Saum  19 , Monika Sawhney  66 , Ben Schöttker  19   67 , Anoop Shankar  68 , Michael Shlipak  52 , Diego Augusto Santos Silva  69 , Hideaki Toyoshima  70 , Kingsley Ukwaja  71 , Mitsumasa Umesawa  72 , Stein Emil Vollset  73   74   26 , David G Warnock  75 , Andrea Werdecker  76 , Kazumasa Yamagishi  77 , Yuichiro Yano  78 , Naohiro Yonemoto  79 , Maysaa El Sayed Zaki  53 , Mohsen Naghavi  26 , Mohammad H Forouzanfar  26 , Christopher J L Murray  26 , Josef Coresh  3 , Theo Vos  26 ; Global Burden of Disease 2013 GFR Collaborators; CKD Prognosis Consortium; Global Burden of Disease Genitourinary Expert Group
Collaborators, Affiliations

Global Cardiovascular and Renal Outcomes of Reduced GFR

Bernadette Thomas et al. J Am Soc Nephrol. 2017 Jul.

Abstract

The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.

Keywords: Epidemiology and outcomes; cardiovascular disease; chronic dialysis; chronic kidney disease; end stage kidney disease.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Higher burden of GFR-attributable deaths and disability-adjusted life years (DALYs) by world region in 2013. (A) Age-standardized deaths per 100,000 in 2013 attributed to reduced GFR. (B) Age-standardized DALYs per 100,000 in 2013 attributed to reduced GFR.
Figure 2.
Figure 2.
Developed world region has lower GFR-attributable age-standardized rates of deaths and DALYs over time. (A) Age-standardized mortality rate attributed to reduced GFR at the global, developed, and developing levels at six time points between 1990 and 2013. (B) Age-standardized DALY rate attributable to reduced GFR at the global, developed, and developing levels at six time points between 1990 and 2013.
Figure 3.
Figure 3.
Fluctuating ranking of GFR risk factor by world region in 2013. Risk factor ranking for deaths in 2013 per 100,000 among seven super-regions. C, Central; E, East; HI, high-income; Latin Am, Latin America; MENA, Middle East and North Africa; PUFA, polyunsaturated fatty acids; S, South; SE, Southeast; Sub-Sah, sub-Saharan.
Figure 4.
Figure 4.
Higher burden of cardiovascular disability-adjusted life years (DALYs) by world region in 2013. Cardiovascular DALYS per 100,000 attributable to reduced GFR in 2013.
Figure 5.
Figure 5.
Higher burden of GFR-attributable CKD (GFR categories 3, 4, 5, and maintenance dialysis) disability-adjusted life years (DALYs) by world region in 2013. CKD DALYs per 100,000 attributable to reduced GFR in 2013.
See this image and copyright information in PMC

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