Abstract: FR-PO488

Relationship of eGFR and ACR to Concurrent Abnormalities in a Global Consortium

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Author

  • Inker, Lesley, CKD Prognosis Consortium, Baltimore, Maryland, United States
Background

CKD is associated with many vascular and laboratory abnormalities. We describe the continuous relationship between abnormalities and CKD staged by eGFR and albuminuria (ACR; A1:<30, A2:30-299, A3:≥300 mg/g).

Methods

Using 12 CKD and 29 general population or high risk (GP/HR) cohorts, we performed random-effects meta-analyses for associations between eGFR (CKD-EPI creatinine equation, expressed as a linear spline with knots at 30, 45, 60, 75, 90 and 105) and the following parameters: systolic blood pressure (SBP, N=629,247), hemoglobin (N=405,633), bicarbonate (N=45,001, CKD cohorts only), phosphorous (N=128,769), parathyroid hormone (PTH, N=47,667), calcium (N=266,009), potassium (N=404,318), and total number of abnormalities (N=17,975, CKD cohorts only). Analyses were adjusted for demographics, comorbid conditions, and ACR stage. We assessed whether associations were modified by ACR stage and by diabetes by including interaction terms.

Results

The CKD cohorts were 52% female and 3% black, with mean age 67 (SD 14). The GP/HR cohorts were 53% female and 4% black, with mean age 53 (SD 18). In the CKD cohorts, lower eGFR was associated with lower hemoglobin and bicarbonate, and higher potassium, phosphorus, PTH and total number of abnormalities. (Figure) For phosphorus, there appeared to be a sharper increase in risk below eGFR <30. Associations with eGFR were relatively flat for SBP and calcium. There was no qualitative differences in associations by level of ACR or diabetes. In the GP/HR cohorts, there was a continuous association between eGFR and potassium; for hemoglobin, phosphorus and PTH, associations were present at eGFR <59, <51 and <70, respectively. Albuminuria was a weak risk factor for metabolic abnormalities.

Conclusion

There was a graded association between potentially reversible metabolic abnormalities and level of GFR with similar associations by ACR stage.

Funding

  • NIDDK Support