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Abstract: FR-PO946

Kidney Function and Mortality in the Mexico City Prospective Study

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Author

  • Aguilar-Ramirez, Diego J., University of Oxford Nuffield Department of Population Health, Oxford, Oxfordshire, United Kingdom

Group or Team Name

  • On Behalf of the Mexico City Prospective Study.
Background

Prospective studies in the US, Europe, Asia, and Australia have shown decreased kidney function is a strong predictor of mortality. There is limited data from Latin America where chronic kidney disease (CKD) is a major cause of morbidity and mortality.

Methods

In 1998-2004, 150,000 adults (aged ≥35 years) were recruited into the Mexico City Prospective Study, and followed for median 19 years. About 120,000 participants currently have nuclear magnetic resonance (NMR) spectroscopy-measured biomarkers in plasma, including creatinine. Cox regression was used to relate a single measurement of baseline eGFR (CKD-EPI equation) to mortality. Analyses were adjusted for age at risk, sex, district, education, smoking, alcohol, physical activity, height, weight, waist and hip circumference, and diabetes. They excluded those who at recruitment had incomplete data or prior chronic disease (except diabetes or CKD).

Results

Among the 33,423 men and 68,133 women aged 35-74 years with complete data, median (IQR) eGFR was 101 (90-109) mL/min/1.73 m2, mean (SD) BMI was 29.1 (4.9) kg/m2, 1% had self-reported CKD, 12% had previously-diagnosed diabetes, and 9,002 died at ages 35-74 years. Despite the inaccuracy of a single eGFR baseline measurement, eGFR <30 mL/min/1.73m2 was associated with eight-fold higher all-cause mortality than eGFR 90-105 (HR 8.5 [95% CI, 9.8-7.5]). Below 90-105, every 15 mL/min/1.73m2 lower eGFR was associated with 40% higher all-cause mortality (HR 1.40 [1.36–1.42] overall, and 1.37 [1.34-1.40] in those without self-reported CKD). eGFR was most strongly associated with renal deaths (HR 29.9 [24.4-36.9] for eGFR <30 vs 90-105) and vascular occlusive deaths (HR 6.2 [4.4-8.7]). Baseline assessments of blood pressure, lipids, and inflammation explained about a third of the association of eGFR with premature mortality.

Conclusion

In this study in Mexico, lower kidney function was strongly associated with increased premature mortality, with the association about twice as strong as previously reported in high-income countries.