Mortality at Low and High Estimated Glomerular Filtration Rate Values: A ‘U’ Shaped CurveCox H.J.a · Bhandari S.b · Rigby A.S.c · Kilpatrick E.S.a
Departments of aClinical Biochemistry, and bRenal Medicine, Hull Royal Infirmary, and cAcademic Department of Cardiology, University of Hull, Hull, UK
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Background: While a low estimated glomerular filtration rate (eGFR) confers an increased risk of dying, the mortality associated with high eGFR values has not been ascertained. Methods: Four variable MDRD-derived eGFR was calculated in a total of 33,386 patients (18,620 F, 14,766 M) aged ≧50 years (median 68 years, IQR 60–76 years) collected by family doctors in 2000. They were then classified according to their eGFR into 30 ml/min/1.73 m2 bands (<30, 30–59, 60–89, 90–119, 120–150). The subsequent mortality status of each patient was determined at 31st December 2006 and cause of death recorded where available. Results: Applying Cox proportional hazards models (adjusted for age and gender), the hazard ratio (HR) of dying compared to a reference of patients with eGFRs of 60–89 ml/min/1.73m2 was, as expected, higher in the low eGFR bands (HR 1.37 (95% CI 1.29–1.45) for 30–59; HR 2.60 (2.31–2.93) for <30 ml/min/1.73 m2, both p < 0.0001). However, it was also greater amongst patients with higher eGFRs (HR 1.29 (1.19–1.41) for 90–119; HR 2.63 (2.16–3.21) for 120–150 ml/min/1.73 m2, p < 0.0001). Circulatory disease was the main cause of death in patients with low eGFRs and respiratory disease/cancer, in patients with high eGFRs. Conclusions: As a marker of mortality, both low and high eGFRs are equally predictive of increased mortality in community patients, exhibiting a ‘U’ shaped curve. Thus, current CKD guidelines which recommend inaction or even the non-reporting of eGFR values greater than 60–90 ml/min/1.73 m2 may not identify patients who are at an equally high risk of dying as those where intervention is recommended.
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- Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G: Definition and classification of chronic kidney disease: A position statement from kidney disease. Improving global outcomes (KDIGO). Kidney Int 2005;67:2089–2100.
National Service Framework for Renal Services – Part Two: Chronic kidney disease, acute renal failure and end of life care, 2005. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4101902. Accessed Jan 21, 2007.
Royal College of Physicians: Chronic Kidney Disease in Adults, UK guidelines for identification, management and referral, 2006. Available at: http://www.renal.org/CKDguide/full/CKDprintedfullguide.pdf. Accessed Feb 24 2007.
- Lamb EJ, Tomson CRV, Roderick PJ: Estimating kidney function in adults using formulae. Ann Clin Biochem 2005;42:321–345.
Levey AS, Greene T, Kusek JW, Beck GJ: MDRD study group, a simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol 2000;11:155A.
- Best PJM, Reddan DN, Berger PB, Szczech LA, McCullough PA, Califf RM: Cardiovascular disease and chronic kidney disease: insights and an update. Am Heart J 2004;148:230–242.
- Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD, Lau J, Eknoyan G: National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137–147.
- Go AS, Chertow GM, Fan DJ, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
- Muntner P, He J, Hamm L, Loria C, Whelton PK: Renal insufficiency and subsequent death resulting from cardiovascular disease in the united states. J Am Soc Nephrol 2002;13:745–753.
- Levey AS, Stevens LA, Hostetter T: Automatic reporting of estimated glomerular filtration rate: just what the doctor ordered. Clin Chem 2006;52:2188.
- Fried LF, Katz R, Sarnak MJ, Shlipak MG, Chaves PHM, Jenny NS, Stehman-Breen C, Gillen D, Bleyer AJ, Hirsch C: Kidney function as a predictor of noncardiovascular mortality. J Am Soc Nephrol 2005;16:3728–3735.
- Shlipak MG, Katz R, Sarnak MJ, Fried LF, Newman AB, Stehman-Breen C, Seliger SL, Kestenbaum B, Psaty B, Tracy RP: Cystatin c and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Ann Intern Med 2006;145:237.
- Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C: Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 2005;352:2049–2060.
- Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999;130:461–470.
MacKenzie F: UK NEQAS for eGFR: a personal view, 2006. Available at: http://www.ukneqas.org.uk/GFR%20Estimations.pdf. Accessed Jan 18 2007.
Neighbourhood Statistics – Hull, 2001. Available at: http://neighbourhood.statistics.gov.uk/dissemination/LeadTableView.do;jsessionid=ac1f930bce6f9509e2c7a8b464cb61794613fade9e4.e38PbNqOa3qRe34Ka3uKbNiSch50n6jAmljGr5XDqQLvpAe?a=3&b=276821&c=Hull&d=13&e=15&g=389985&i=1001x1003x1004&m=0&enc=1&dsFamilyId=47&bhcp=1. Accessed Jan 18 2007.
Neighbourhood Statistics – East Riding of Yorkshire, 2001 Available at: http://neighbourhood.statistics.gov.uk/dissemination/LeadTableView.do?a=3&b=276822&c=east+ riding+of+yorkshire&d=13&e=15&g=390682&i=1001x1003x1004&m=0&enc=1&dsFamilyId=47. Accessed Jan 18 2007.
World Health Organization: International Classification of Diseases (ICD), 1994. Available at: http://www.who.int/classifications/icd/en/. Accessed Jun 7 2007.
Grambsch PM, Therneau TM: Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 1994;82:515–526.
- Weiner DE, Tighiouart H, Amin MG, Stark PC, MacLeod B, Griffith JL, Salem DN, Levey AS, Sarnak MJ: Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004;15:1307–1315.
- Garg AX, Clark WF, Haynes RB, House AA: Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int 2002;61:1486–1494.
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