Glomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease

Lees, J. S. et al. (2019) Glomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease. Nature Medicine, 25, pp. 1753-1760. (doi: 10.1038/s41591-019-0627-8) (PMID:31700174) (PMCID:PMC6858876)

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Abstract

Chronic kidney disease is common in the general population and associated with excess cardiovascular disease (CVD), but kidney function does not feature in current CVD risk-prediction models. We tested three formulae for estimated glomerular filtration rate (eGFR) to determine which was the most clinically informative for predicting CVD and mortality. Using data from 440,526 participants from UK Biobank, eGFR was calculated using serum creatinine, cystatin C (eGFRcys) and creatinine-cystatin C. Associations of each eGFR with CVD outcome and mortality were compared using Cox models and adjusting for atherosclerotic risk factors (per relevant risk scores), and the predictive utility was determined by the C-statistic and categorical net reclassification index. We show that eGFRcys is most strongly associated with CVD and mortality, and, along with albuminuria, adds predictive discrimination to current CVD risk scores, whilst traditional creatinine-based measures are weakly associated with risk. Clinicians should consider measuring eGFRcys as part of cardiovascular risk assessment.

Item Type:Articles
Additional Information:A correction to this article is available at https://doi.org/10.1038/s41591-020-0996-z.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Celis, Dr Carlos and Gray, Dr Stuart and Gill, Professor Jason and Mark, Dr Patrick and Welsh, Dr Paul and Jhund, Dr Pardeep and Lees, Jennifer and Pell, Professor Jill and Mackay, Professor Daniel and Lewsey, Professor Jim and Cleland, Professor John and Sattar, Professor Naveed and Welsh, Dr Claire and Lyall, Dr Donald
Authors: Lees, J. S., Welsh, C. E., Celis-Morales, C. A., Mackay, D., Lewsey, J., Gray, S. R., Lyall, D. M., Cleland, J. G., Gill, J. M.R., Jhund, P. S., Pell, J., Sattar, N., Welsh, P., and Mark, P. B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Nature Medicine
Publisher:Nature Publishing Group
ISSN:1078-8956
ISSN (Online):1546-170X
Published Online:07 November 2019
Copyright Holders:Copyright © 2019 Springer Nature
First Published:First published in Nature Medicine 25:1753-1760
Publisher Policy:Reproduced in accordance with the publisher copyright policy
Related URLs:

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190814BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177Institute of Cardiovascular & Medical Sciences
172776Associations of blood biomarkers with cardiovascular disease and related cardiometabolic outcomes and risk prediction in the clinical setting: UK biobankNaveed SattarChest Heart and Stroke Scotland (CHSS)Res16/A165Institute of Cardiovascular & Medical Sciences
300923Vitamin K in Transplanted Kidney Organ Recipients: Investigating vEssel Stiffness (ViKTORIES)Jennifer LeesKidney Research UK (KIDNEYRE)TF_013_20161125CAMS - Cardiovascular Science