A meta-analysis of the association of estimated GFR, albuminuria, diabetes mellitus, and hypertension with AKI

Background— Diabetes mellitus and hypertension are risk factors for acute kidney injury (AKI). Whether estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) remain risk factors for AKI in the presence and absence of these conditions is uncertain. Study Design— Meta-analysis of cohort studies. Setting & Population— 8 general population (1,285,045 participants) and 5 CKD (79,519 participants) cohorts. Selection Criteria for Studies— Cohorts participating in the CKD Prognosis Consortium. Predictors— Diabetes and hypertension status, eGFR by the CKD Epidemiology Collaboration 2009 creatinine equation, urine ACR, and interactions. Outcome— Hospitalization with AKI, using Cox proportional hazards models to estimate hazard ratios (HR) of AKI and random effects meta-analysis to pool results. Results— Over a mean follow-up period of 4 years, there were 16,480 episodes of AKI in the general population and 2,087 episodes in the CKD cohorts. Low eGFR and high ACR were associated with higher risks of AKI in individuals with or without diabetes and with or without hypertension. When compared to a common reference of eGFR 80 mL/min/1.73m 2 in non-diabetic patients, HRs for AKI were generally higher in diabetic patients at any level of eGFR. The same was true for diabetic patients at all levels of ACR compared to non-diabetic patients. The risk gradient for AKI with lower eGFR was greater in those without diabetes than with diabetes, but similar with higher ACR in those without versus with diabetes. Those with hypertension had a higher risk of AKI at eGFR greater than 60 ml/min/1.73m 2 than those without hypertension. However, the risk gradients for AKI with both lower eGFR and higher ACR were greater for those without than with hypertension. Limitations— AKI identified by diagnostic code. Conclusions— Lower eGFR and higher ACR are associated with higher risks of AKI among individuals with or without either diabetes or hypertension.

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