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Global Cardiovascular and Renal Outcomes of Reduced GFR

Thomas B 1 , Matsushita K 2 , Abate KH 3 , Al-Aly Z 4 , Ärnlöv J 5 , Asayama K 6 Show all authors , Atkins R 7 , Badawi A 8 , Ballew SH 2 , Banerjee A 9 , Barregård L 10 , Barrett-Connor E 11 , Basu S 12 , Bello AK 13 , Bensenor I 14 , Bergstrom J 11 , Bikbov B 15 , Blosser C 16 , Brenner H 17 , Carrero JJ 18 , Chadban S 19 , Cirillo M 20 , Cortinovis M 21 , Courville K 21 , Dandona L 22 , Dandona R 22 , Estep K 22 , Fernandes J 23 , Fischer F 24 , Fox C 25 , Gansevoort RT 26 , Gona PN 27 , Gutierrez OM 28 , Hamidi S 29 , Hanson SW 22 , Himmelfarb J 16 , Jassal SK 30 , Jee SH 31 , Jha V 32 , Jimenez-Corona A 33 , Jonas JB 34 , Kengne AP 35 , Khader Y 36 , Khang YH 37 , Kim YJ 38 , Klein B 39 , Klein R 39 , Kokubo Y 40 , Kolte D 41 , Lee K 42 , Levey AS 43 , Li Y 44 , Lotufo P 14 , El Razek HMA 45 , Mendoza W 46 , Metoki H 47 , Mok Y 31 , Muraki I 48 , Muntner PM 49 , Noda H 50 , Ohkubo T 6 , Ortiz A 51 , Perico N 21 , Polkinghorne K 52 , Al-Radaddi R 53 , Remuzzi G 21 , Roth G 22 , Rothenbacher D 54 , Satoh M 47 , Saum KU 17 , Sawhney M 55 , Schöttker B 17 , Shankar A 56 , Shlipak M 44 , Silva DAS 57 , Toyoshima H 58 , Ukwaja K 59 , Umesawa M 60 , Vollset SE 61 , Warnock DG 62 , Werdecker A 63 , Yamagishi K 64 , Yano Y 65 , Yonemoto N 66 , Zaki MES 45 , Naghavi M 22 , Forouzanfar MH 22 , Murray CJL 22 , Coresh J 2 , Vos T 22 , Global Burden of Disease 2013 GFR Collaborators , CKD Prognosis Consortium , Global Burden of Disease Genitourinary Expert Group

Affiliations 

  • 1 Institute for Health Metrics and Evaluation, bathomas@uw.edu
  • 2 Department of Epidemiology and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  • 3 Jimma University, Jimma, Ethiopia
  • 4 Washington University in St. Louis, St. Louis, Missouri
  • 5 Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
  • 6 Teikyo University School of Medicine, Tokyo, Japan
  • 7 Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
  • 8 Public Health Agency of Canada, Toronto, Ontario, Canada
  • 9 Farr Institute of Health Informatics Research, University College London, London, England, United Kingdom
  • 10 Department of Occupational and Environmental Health, University of Gothenburg, Gothenburg, Sweden
  • 11 Department of Family Medicine and Public Health
  • 12 Stanford University, Stanford, California
  • 13 Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  • 14 University of São Paulo, São Paulo, Brazil
  • 15 Department of Nephrology Issues of Transplanted Kidney, Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
  • 16 Internal Medicine, Nephrology, University of Washington, Seattle, Washington
  • 17 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
  • 18 Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
  • 19 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia
  • 20 University of Salerno, Baronissi, Italy
  • 21 Istituto Di Ricovero E Cura A Carattere Scientifico, Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
  • 22 Institute for Health Metrics and Evaluation
  • 23 Center for Biotechnology and Fine Chemistry, Associate Laboratory, Faculty of Biotechnology, Catholic University of Portugal, Porto, Portugal
  • 24 Bielefeld University, Bielefeld, Germany
  • 25 National Heart, Lung, and Blood Institute, Framingham, MA
  • 26 University Medical Center Groningen, Groningen, Netherlands
  • 27 University of Massachusetts Boston, Boston, MA
  • 28 School of Medicine and
  • 29 Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  • 30 Veterans Affairs, University of California, San Diego, San Diego, California
  • 31 Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
  • 32 George Institute for Global Health, New Delhi, India
  • 33 Department of Ocular Epidemiology and Visual Health, Institute of Ophthalmology Conde de Valencia, Mexico City, Mexico
  • 34 Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
  • 35 South African Medical Research Council, Cape Town, South Africa
  • 36 Jordan University of Science and Technology, Irbid, Jordan
  • 37 College of Medicine, Seoul National University, Seoul, South Korea
  • 38 Southern University College, Skudai, Malaysia
  • 39 Department of Ophthalmology and Visual Sciences and
  • 40 Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
  • 41 Division of Cardiology, Brown University, Providence, Rhode Island
  • 42 Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI
  • 43 Division of Nephrology, Tufts Medical Center, Boston, MA
  • 44 General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA
  • 45 Mansoura Faculty of Medicine, Mansoura, Egypt
  • 46 United Nations Population Fund, Lima, Peru
  • 47 Tohoku University, Sendai, Japan
  • 48 Osaka Medical Center for Cancer and Cardiovascular Diseases Prevention, Osaka, Japan
  • 49 Departments of Epidemiology and
  • 50 Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
  • 51 IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
  • 52 Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia
  • 53 Ministry of Health, Jeddah, Saudi Arabia
  • 54 Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
  • 55 Marshall University, Huntington, WV
  • 56 St. Louis, MO
  • 57 Federal University of Santa Catarina, Florianopolis, Brazil
  • 58 Health Care Center of Anjo Kosei Hospital, Anjo City, Japan
  • 59 Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
  • 60 Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
  • 61 Center for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
  • 62 Medicine, University of Alabama at Birmingham, Birmingham, AL
  • 63 Competence Center Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany
  • 64 Department of Public Health Medicine, University of Tsukuba, Tsukuba, Japan
  • 65 Department of Preventive Medicine, Northwestern University, Chicago, IL; and
  • 66 **************Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
J Am Soc Nephrol, 2017 Jul;28(7):2167-2179.
PMID: 28408440 DOI: 10.1681/ASN.2016050562

Abstract

The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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