Abstract: SA-OR35
Comprehensive Evaluation of CKD Heat Map
Session Information
- Epidemiology of CKD Progression: Who, Why, and When?
November 04, 2023 | Location: Room 119, Pennsylvania Convention Center
Abstract Time: 05:33 PM - 05:42 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Grams, Morgan, CKD Prognosis Consortium, Baltimore, Maryland, United States
- Gansevoort, Ron T., CKD Prognosis Consortium, Baltimore, Maryland, United States
Group or Team Name
- CKD Prognosis Consortium.
Background
The 2012 KDIGO heat map framework for CKD analyzed five outcomes in 1.2 million participants. We comprehensively evaluated this framework using new equations for eGFR using creatinine alone and in combination with cystatin C (eGFRcr and eGFRcr-cys; CKD-EPI 2021 and EKFC) and more categories of albuminuria, assessing their individual and combined associations with ten adverse outcomes, overall and by age, sex, diabetes, and cardiovascular disease.
Methods
Individual-level data analysis: 27,503,140 participants from 114 global cohorts (eGFRcr); 720,736 participants from 20 cohorts (eGFRcr-cys). Outcomes: kidney failure with replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease.
Results
Mean participant eGFRcr was 90 ml/min/1.73 m2 (SD, 22) and median ACR was 11 mg/g (interquartile range 8-16 mg/g). Lower eGFRcr and higher ACR were associated with higher risk of all ten adverse outcomes, including in the mildest categories of CKD (eGFR 45-59 ml/min/1.73 m2 and ACR <30 mg/g, or ACR 30-299 mg/g) and within subgroups. Associations were generally stronger and with less U-shape in the higher range of eGFR for eGFRcr-cys compared with eGFRcr.
Conclusion
This comprehensive evaluation of the heatmap framework in >27 million people demonstrated that the framework holds for associations with previous endpoints as well as novel kidney and cardiovascular endpoints; across subgroups of age, sex, diabetes, and cardiovascular disease; and for different GFR equations, including those incorporating cystatin C.
Funding
- NIDDK Support