Change in albuminuria and subsequent risk of end-stage kidney disease: An individual participant-level consortium meta-analysis of observational studies
Abstract
Background: There is strong biologic plausibility to support change in albuminuria as a surrogate endpoint for progression of chronic kidney disease (CKD), but empirical evidence to supports its validity in epidemiologic studies is lacking. Methods: We analyzed 28 cohorts including 693,816 individuals (80% with diabetes) and 7,461 end-stage kidney disease (ESKD) events, defined as initiation of kidney replacement therapy. Percent change in albuminuria was quantified during a baseline period of 1, 2 and 3 years using linear regression. Associations with subsequent ESKD were quantified using Cox regression in each cohort, followed by random-effects meta-analysis. Further adjustment for regression dilution was used to take into account the high variability of albuminuria. Findings: Change in urine albumin-to-creatinine ratio (ACR) was consistently related to subsequent risk of ESKD. The adjusted hazard ratio of ESKD following a 30% decrease in ACR during a 2-year baseline period was 0.83 (95% CI 0.74–0.94); after further adjustment for regression dilution it was 0.78 (95% CI 0.66–0.92). Adjusted hazard ratios were relatively consistent across cohorts and subgroups but were somewhat stronger at higher ACR (p-interaction30 mg/g, an average reduction in ACR of 30% over 2-years was estimated to confer >1% absolute reduction in 10-year ESKD risk, even at earlier stages of CKD. Results were generally similar when using change in urine protein-to-creatinine ratio (PCR), or when study…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 693,816 participants or records.
Read the paper
Related studies
- A Survey on Knowledge Graphs: Representation, Acquisition, and Applications
- Toxicity of nanomaterials
- The Human Gene Mutation Database: towards a comprehensive repository of inherited mutation data for medical research, genetic diagnosis and next-generation sequencing studies
- Halogen bonding (X‐bonding): A biological perspective
- Biofilm formation at the air–liquid interface by the Pseudomonas fluorescens SBW25 wrinkly spreader requires an acetylated form of cellulose
- Opioid Activation of Toll-Like Receptor 4 Contributes to Drug Reinforcement
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.