Eerily-timed (from a mailbase perspective)
The Lancet, Volume 375, Issue 9731, Pages 2073 - 2081, 12 June 2010
Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
Background
Substantial controversy surrounds the use of estimated glomerular filtration rate (eGFR) and albuminuria to define chronic kidney disease and assign its stages. We undertook a meta-analysis to assess the independent and combined associations of eGFR and albuminuria with mortality.
Findings
The analysis included 105 872 participants (730 577 person-years) from 14 studies with urine albumin-to-creatinine ratio (ACR) measurements and 1 128 310 participants (4 732 110 person-years) from seven studies with urine protein dipstick measurements. In studies with ACR measurements, risk of mortality was unrelated to eGFR between 75 mL/min/1·73 m2 and 105 mL/min/1·73 m2 and increased at lower eGFRs. Compared with eGFR 95 mL/min/1·73 m2, adjusted HRs for all-cause mortality were 1·18 (95% CI 1·05—1·32) for eGFR 60 mL/min/1·73 m2, 1·57 (1·39—1·78) for 45 mL/min/1·73 m2, and 3·14 (2·39—4·13) for 15 mL/min/1·73 m2. ACR was associated with risk of mortality linearly on the log-log scale without threshold effects. Compared with ACR 0·6 mg/mmol, adjusted HRs for all-cause mortality were 1·20 (1·15—1·26) for ACR 1·1 mg/mmol, 1·63 (1·50—1·77) for 3·4 mg/mmol, and 2·22 (1·97—2·51) for 33·9 mg/mmol. eGFR and ACR were multiplicatively associated with risk of mortality without evidence of interaction. Similar findings were recorded for cardiovascular mortality and in studies with dipstick measurements.
Interpretation
eGFRless than 60 mL/min/1·73 m2 and ACR 1·1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960674-5/abstract?elsca1=TL-110610&elsca2=email&elsca3=segment
___________________________________________
Adrian G Miller BSc MSc PhD
Pre-Registration Clinical Biochemist
Biochemistry Department
Royal Preston Hospital
Sharoe Green Lane
Fulwood
Preston
Lancashire
PR2 9HT
Tel. 01772 522342
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Hallworth Mike (RLZ) [[log in to unmask]]
Sent: 10 June 2010 09:48
To: [log in to unmask]
Subject: Re: GFR
Hi Anders
I'm glad we amuse you, but it is worth noting that the introduction of
eGFR reporting in the UK has had a significant impact on getting faster
referrals to specialist renal care, with one report stating that the
number of patients referred late for specialist care fell from 38% to
25% following eGFR introduction (Bebb and Burden, BMJ 2007; 334: 1287).
This is supported by data from the UK Renal Registry. So there is
evidence that patients benefit, even though eGFR may not satisfy the
metrologists!
Mike
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Anders Kallner
Sent: 09 June 2010 17:19
To: [log in to unmask]
Subject: GFR
It amuses me to note that the UK (and US)colleagues still seem to
believe that S-Creatinine concentrations can be used to diagnose CKD in
spite of the large biological inter individual variation that Callum
Fraser (Dundee) nicely demonstrated in 80-ies. The variation is not
decreased by multiplying the measured S-Creatinine concentration by one
or other constant. On the contrary the gender and age variations
increase by the operation. You may still very well use the S-Creatinine
concentration to monitor disease and the mutilated value, erroneously
referred to as GFR, as well.
Anders Kallner
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