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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005741naa a2200625 4500
001oai:DiVA.org:uu-229127
003SwePub
008140731s2014 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-2291272 URI
0247 a https://doi.org/10.1001/jama.2014.66342 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Coresh, Josef4 aut
2451 0a Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality
264 1b American Medical Association (AMA),c 2014
338 a print2 rdacarrier
500 a Collaborators:  Anders Larsson, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion, Johan Ärnlöv, Institutionen för medicinska vetenskaper, Molekylär epidemiologi och Lars Lannfelt, lalan021. Samtliga ingår i the Chronic Kidney Disease Prognosis Consortium.
520 a IMPORTANCE: The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of −57% or greater) is a late event.OBJECTIVE: To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated.DATA SOURCES AND STUDY SELECTION: Individual meta-analysis of 1.7 million participants with 12,344 ESRD events and 223,944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data.DATA EXTRACTION AND SYNTHESIS: Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012.MAIN OUTCOMES AND MEASURES: End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR.RESULTS: The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of −57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of −30%. However, changes of −30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of −57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99% (95% CI, 95%-100%) for estimated GFR change of −57%, was 83% (95% CI, 71%-93%) for estimated GFR change of −40%, and was 64% (95% CI, 52%-77%) for estimated GFR change of −30% vs 18% (95% CI, 15%-22%) for estimated GFR change of 0%. Corresponding mortality risks were 77% (95% CI, 71%-82%), 60% (95% CI, 56%-63%), and 50% (95% CI, 47%-52%) vs 32% (95% CI, 31%-33%), showing a similar but weaker pattern.CONCLUSIONS AND RELEVANCE: Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskapx Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi0 (SwePub)303022 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Health Sciencesx Public Health, Global Health, Social Medicine and Epidemiology0 (SwePub)303022 hsv//eng
650 7a MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskap0 (SwePub)3032 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Health Sciences0 (SwePub)3032 hsv//eng
7001 a Turin, Tanvir Chowdhury4 aut
7001 a Matsushita, Kunihiro4 aut
7001 a Sang, Yingying4 aut
7001 a Ballew, Shoshana H4 aut
7001 a Appel, Lawrence J4 aut
7001 a Arima, Hisatomi4 aut
7001 a Chadban, Steven J4 aut
7001 a Cirillo, Massimo4 aut
7001 a Djurdjev, Ognjenka4 aut
7001 a Green, Jamie A4 aut
7001 a Heine, Gunnar H4 aut
7001 a Inker, Lesley A4 aut
7001 a Irie, Fujiko4 aut
7001 a Ishani, Areef4 aut
7001 a Ix, Joachim H4 aut
7001 a Kovesdy, Csaba P4 aut
7001 a Marks, Angharad4 aut
7001 a Ohkubo, Takayoshi4 aut
7001 a Shalev, Varda4 aut
7001 a Shankar, Anoop4 aut
7001 a Wen, Chi Pang4 aut
7001 a de Jong, Paul E4 aut
7001 a Iseki, Kunitoshi4 aut
7001 a Stengel, Benedicte4 aut
7001 a Gansevoort, Ron T4 aut
7001 a Levey, Andrew S4 aut
7730 t Journal of the American Medical Association (JAMA)d : American Medical Association (AMA)g 311:24, s. 2518-2531q 311:24<2518-2531x 0098-7484x 1538-3598
8564 u https://jamanetwork.com/journals/jama/articlepdf/1878665/joi140077.pdf
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-229127
8564 8u https://doi.org/10.1001/jama.2014.6634

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