Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 29;9(8):2537-2545.
doi: 10.1016/j.ekir.2024.05.025. eCollection 2024 Aug.

Prospective Study on Kidney Dysfunction Markers and Risk for Mortality among South Asians

Ram Jagannathan  1 , Shuchi Anand  2   3   4 , Dimple Kondal  2   3 , Jialin Han  4 , Maria Montez-Rath  4 , Mohammed K Ali  1   2 , Shivani A Patel  1   3 , Kavita Singh  3 , Roopa Shivashankar  5 , R M Anjana  6 , Ruby Gupta  2   3 , Sailesh Mohan  2   3 , Glenn M Chertow  4 , Viswanathan Mohan  6 , Nikhil Tandon  7 , K M Venkat Narayan  1   2 , Dorairaj Prabhakaran  2   3
Affiliations

Prospective Study on Kidney Dysfunction Markers and Risk for Mortality among South Asians

Ram Jagannathan et al. Kidney Int Rep. .

Abstract

Introduction: Associations between markers of impaired kidney function and adverse outcomes among South Asians is understudied and could differ from existing data derived mostly from North American or European cohorts.

Methods: We conducted a prospective analysis of 9797 participants from the ongoing cardiometabolic risk reduction study in South Asia, India. We examined the associations between baseline spot urine albumin-to-creatinine (UACR) ratio and creatinine-based estimated glomerular filtration rate (eGFR) estimating equations with all-cause mortality using Cox proportional hazards regression, adjusting for baseline age, sex, diabetes, systolic blood pressure, tobacco, history of cardiovascular disease, and cholesterol. Additionally, we calculated population attributable fraction (PAF) for both markers.

Results: Over a median 7-year follow-up, with 66,909 person-years, 791 deaths occurred. At baseline, the weighted prevalence of UACR ≥ 30 mg/g and eGFRCKD-EPI 2009 <60 ml/min per 1.73 m2 was 6.6% and 1.6%, respectively. The risk for mortality was increased with higher UACR (10-30 hazard ratio [HR]: 1.6 [1.2-2.1]), 30-300 HR: 2.4 [1.8-3.1]), and ≥300 (HR: 6.0 [3.8-9.4] relative to UACR <10 mg/g). Risk for mortality was also higher with lower eGFRCKD-EPI 2009 (44-30; HR: 4.5 [2.5-8.3] and <30 HR: 7.0 [3.7-13.0], relative to 90-104 ml/min per 1.73 m2). PAF for mortality because of UACR ≥30 mg/g and eGFRCKD-EPI 2009 <45 ml/min per 1.73 m2 were 24.4% and 13.4%, respectively.

Conclusion: Single-time point assessment of UACR ≥30 mg/g or eGFRCKD-EPI 2009 <45 ml/min per 1.73 m2 portends higher mortality risk among urban South Asians. Because albuminuria is common and associated with accelerated decline in GFR, screening and targeted efforts to reduce albuminuria are warranted.

Keywords: South Asians; albuminuria; glomerular filtration rate; mortality.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Association between kidney function and mortality in subgroups of interest (a) for UACR (<30 mg/g vs. ≥ 30 mg/g), (b) for eGFRCKD-EPI 2009 (>45 vs. <45 ml/min per 1.73 m2).
Figure 2
Figure 2
eGFR distributions according to 4 creatinine-based formulae. CKD-EPI, CKD Epidemiology Collaboration; EFKC,European Kidney Function Consortium; PK,Pakistan
See this image and copyright information in PMC

References

    1. Stevens P.E., Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Kidney disease: improving global outcomes chronic kidney disease guideline development work group M. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158:825–830. doi: 10.7326/0003-4819-158-11-201306040-00007. - DOI - PubMed
    1. Anand S., Shivashankar R., Ali M.K., et al. Prevalence of chronic kidney disease in two major Indian cities and projections for associated cardiovascular disease. Kidney Int. 2015;88:178–185. doi: 10.1038/ki.2015.58. - DOI - PMC - PubMed
    1. Coresh J., Selvin E., Stevens L.A., et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–2047. doi: 10.1001/jama.298.17.2038. - DOI - PubMed
    1. Gujral U.P., Pradeepa R., Weber M.B., Narayan K.M., Mohan V. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013;1281:51–63. doi: 10.1111/j.1749-6632.2012.06838.x. - DOI - PMC - PubMed
    1. Unnikrishnan R.I., Rema M., Pradeepa R., et al. Prevalence and risk factors of diabetic nephropathy in an urban south Indian population: the Chennai Urban Rural Epidemiology Study (CURES 45) Diabetes Care. 2007;30:2019–2024. doi: 10.2337/dc06-2554. - DOI - PubMed

LinkOut - more resources