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Decreased Kidney Function Predicts Death Risk in General Population
  from Jules: in the general population kidney function declines with age and in HIV it does appear as though patients are in general experiencing accelerated aging or premature comorbidities. HIV+ individuals often have more risk factors for kidney dysfunction including a history of substance abuse, being African-American, diabetes (perhaps insulin resistance causes decline in kidney function), recent studies at conferences have been reported HIV+ individuals more often have proteinuria, an association between certain ARTs and kidney function, and HIV appears to be reswrvoired in the kidney. All suggesting that as the HIV patient population ages kidney function is likely to decline perhaps more than in the general population. Aging appears to be perhaps the number 1 concern for patients. Aging research has begiun to gain traction, the 1st Intl Aging/HIV Workshop is scheduled for Oct 2010 in Baltimore. We must get an understanding of how we can hopefull prevent premature and early onset for these comorbidities including besides kidnet disease - cardiovascular, diabetes, cancers, bone, the brain/CNS.
MedPage Today
Published: May 17, 2010
Two measures of impaired renal function are independent predictors of increased mortality risk among the general population, a meta-analysis showed.
Action Points
* Explain to interested patients that this meta-analysis suggested that both estimated glomerular filtration rate and urinary albumin-to-creatinine ratio (ACR) may be useful in defining and staging chronic kidney disease.
* This meta-analysis suggests, but does not establish a cause and effect, for increased mortality risk among individuals with a higher urine ACR and a reduced glomerular filtration rate.
Estimated glomerular filtration rates (eGFRs) of 60 mL/min/1.73 m2 or lower and urine albumin-to-creatinine ratios (ACR) of 1.1 or higher were associated with a greater risk of death in a pooled analysis of 21 studies, according to Josef Coresh, MD, PhD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues from the International Chronic Kidney Disease Prognosis Consortium.
The findings are consistent with thresholds set by the Kidney Disease Outcomes Quality Initiative -- eGFR of 60 mL/min/1.73 m2 or less and albumin-to-creatinine ratio of 3.4 or higher -- for increased mortality, the researchers reported online in The Lancet.
In an accompanying editorial, Roberto Pontremoli, MD, PhD, of the University of Genoa in Italy, and colleagues, wrote, "Data from today's meta-analysis confirm beyond doubt that the current thresholds are indicative of increased all-cause and cardiovascular mortality risk."
The findings "will hopefully promote greater use of renal function tests in clinical practice aimed at global risk assessment," they said.
According to Coresh and his colleagues, there is continuing controversy around the use of eGFR and the presence of urinary albuminuria (protein in urine) to define chronic kidney disease and assign its stages.
They performed the meta-analysis to evaluate the associations of each measure -- both separately and combined -- with mortality in cohorts from the general population.
The analysis included 21 studies from Asia, Europe, North America, and Australia -- 14 with 105,872 total participants and urine albumin-to-creatinine ratio measurements and seven with 1,128,310 participants and urine protein dipstick measurements.
Through a median follow-up of 7.9 years, there were 45,584 deaths, including 9,637 from cardiovascular disease.
In the studies with ACR measurements, eGFRs between 75 and 105 mL/min/1.73 m2 were not significantly associated with mortality, but lower eGFRs were linked with a greater risk of death.
Compared with an eGFR of 95 mL/min/1.73 m2, the adjusted hazard ratios for all-cause mortality were 1.18 (95% CI 1.05 to 1.32) for 60 mL/min/1.73 m2, 1.57 (95% CI 1.39 to 1.78) for 45 mL/min/1.73 m2, and 3.14 (95% CI 2.39 to 4.13) for 15 mL/min/1.73 m2.
The hazard ratios tended to be higher in participants younger than 65 than in older patients, although tests for an interaction between eGFR and age did not reach statistical significance in most studies.
Urine albumin-to-creatinine ratio was associated with mortality in a linear fashion.
Compared with a ratio of 0.6 mg/mmol, the adjusted hazard ratios for all-cause mortality were 1.20 (95% CI 1.15 to 1.26) for 1.1 mg/mmol, 1.63 (95% CI 1.50 to 1.77) for 3.4 mg/mmol, and 2.22 (95% CI 1.97 to 2.51) for 33.9 mg/mmol.
All of the findings were similar in studies using dipstick measurements and when cardiovascular mortality was the outcome.
Both measures of reduced kidney function independently predicted mortality risk and, in most studies, did not have significant interactions with each other.
"In other words," the editorialists wrote, "knowing one's level of urine albumin excretion provides additional prognostic information for almost any given value of eGFR, and vice versa."
Coresh and his colleagues noted that the meta-analysis had several limitations:a lack of uniform study protocol and centralized analysis of laboratory results for all cohorts, and no standardized measurements for creatinine and albuminuria.
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