Background A comprehensive evaluation of the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality is required for assessment of the impact of kidney function on risk in the general population, with implications for improving the definition and staging of chronic kidney disease (CKD). Methods A collaborative meta-analysis of general population cohorts was undertaken to pool standardized data for all-cause and cardiovascular mortality. The two kidney measures and potential confounders from 14 studies (105,872 participants; 730,577 person-years) with urine albumin-to-creatinine ratio (ACR) measurements and seven studies (1,128,310 participants; 4,732,110 person-years) with urine protein dipstick measurements were modeled. Findings In ACR studies, mortality risk was unrelated to eGFR between 75-105 ml/min/1·73 m2 and increased at lower eGFR. Adjusted hazard ratios (HRs) for all-cause mortality at eGFR 60, 45, and 15 (versus 95) ml/min/1·73 m2 were 1·18 (95% CI: 1·05-1·32), 1·57 (1·39-1·78), and 3·14 (2·39-4·13), respectively. ACR was associated with mortality risk linearly on the log-log scale without threshold effects. Adjusted HRs for all-cause mortality at ACR 10, 30, and 300 (versus 5) mg/g were 1·20 (1·15-1·26), 1·63 (1·50-1·77), and 2·22 (1·97-2·51). eGFR and ACR were multiplicatively associated with mortality without evidence of interaction. Similar findings were observed for cardiovascular mortality and in dipstick studies. Interpretation Lower eGFR (<60 ml/min/1·73 m2) and higher albuminuria (ACR ≥10 mg/g) were independent predictors of mortality risk in the general population. This study provides quantitative data for using both kidney measures for risk evaluation and CKD definition and staging.

Chronic kidney disease (CKD) is common among the elderly. However, little is known about how the clinical implications of CKD vary with age. We examined the age-specific incidence of death, treated end-stage renal disease (ESRD), and change in estimated glomerular filtration rate (eGFR) among 209,622 US veterans with CKD stages 3 to 5 followed for a mean of 3.2 years. Patients aged 75 years or older at baseline comprised 47% of the overall cohort and accounted for 28% of the 9227 cases of ESRD that occurred during follow-up. Among patients of all ages, rates of both death and ESRD were inversely related to eGFR at baseline. However, among those with comparable levels of eGFR, older patients had higher rates of death and lower rates of ESRD than younger patients. Consequently, the level of eGFR below which the risk of ESRD exceeded the risk of death varied by age, ranging from 45 ml/min per 1.73 m 2 for 18 to 44 year old patients to 15 ml/min per 1.73 m 2 for 65 to 84 year old patients. Among those 85 years or older, the risk of death always exceeded the risk of ESRD in this cohort. Among patients with eGFR levels Ͻ45 ml/min per 1.73 m 2 at baseline, older patients were less likely than their younger counterparts to experience an annual decline in eGFR of Ͼ3 ml/min per 1.73 m 2 . In conclusion, age is a major effect modifier among patients with an eGFR of Ͻ60 ml/min per 1.73 m 2 , challenging us to move beyond a uniform stage-based approach to managing CKD. 18: 275818: -276518: , 200718: . doi: 10.1681 Chronic kidney disease (CKD) is common in the elderly, 1,2 leading some professional organizations to recommend routine age-based screening for CKD in the primary care setting 3 ; however, relatively little is known about the clinical course of CKD in older individuals. Most previous studies of CKD and current recommendations for its management have not distinguished between patients of different ages, and efforts to identify risk factors for progression of CKD have generally focused on patient characteristics other than age. 4 -17 We hypothesized that the frequency of clinically significant outcomes among patients who meet National Kidney Foundation criteria for stages 3 to 5 CKD would differ substantially across age groups. We tested this hypothesis among a national cohort J Am Soc Nephrol

Abstract. The purpose of this retrospective cohort study was to examine the associations among chronic kidney disease, anemia, and risk of death among patients with heart failure. Retrospective cohort study. Patients with a principal diagnosis of heart failure (ICD9 codes 402. 01, 402.11, 402.91, 404.01, 404.11, 404.91, and 428.xx) were included. Chronic kidney disease (CKD) was defined as a serum creatinine Ͼ1.4 mg/dl for women and Ͼ1.5 mg/dl for men. There were 665 eligible patients in the sample with a mean (SD) age of 75.7 (10.9) yr; 60% were women, 71% were white, and 38% had CKD. On admission, a hematocrit Ն40% was found for 30.3% of the patients; 22.9% had a hematocrit between 36% and 40%, 33.2% between 30% and 35%, and 13.6% had a hematocrit of Ͻ30%. The 1-yr death rates among individuals with and without CKD were 44.9% and 31.4%, respectively (relative risk [RR], 1.43; 95% confidence interval [CI], 1.17 to 1.75). The mortality at 1 yr was 31.2% for individuals with a hematocrit Ն40%; 33.8% (RR, 1.08; 95% CI. 0.79 to 1.47) for hematocrit 36 to 39%; 36.7% (RR, 1.17; 95% CI, 0.89 to 1.54) for hematocrit between 30 and 35%; and 50.0% (RR, 1.60; 95% CI, 1.19 to 2.16) for those with a hematocrit Ͻ30% ( 2 for trend was 7.37; P ϭ 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. In conclusion, CKD and anemia are frequent among older patients with heart failure and are independent predictors of subsequent risk of death.Anemia is a frequent complication of chronic kidney disease (CKD) and is primarily due to failure of erythropoietin production to respond to decreased hemoglobin concentration (1,2). The onset of anemia during the progression of CKD is variable, but it is common after serum creatinine reaches 1.5 mg/dl and increases in prevalence with decreasing creatinine clearance (3,4). At the onset of end-stage renal disease (ESRD), the mean hematocrit is Ͻ30%, despite the use of erythropoietin replacement in over a quarter of new patients (5). A recent report by al- Ahmad et al. (6) found that CKD and anemia are independent risk factors for mortality among patients with heart failure due to left ventricular dysfunction (i.e., an ejection fraction Յ35%) enrolled in the Studies of LV Dysfunction (SOLVD) clinical trial. Increased risk of death was noted among patients with a hematocrit between 35 and 39% as well as those with more severe degrees of anemia. This report is of particular interest given that the prevalence of heart failure was 33% among new ESRD patients (5).Although CKD has been a known risk factor for mortality among patients with heart failure, the findings of al-Ahmad et al. were unexpected, as a contribution of anemia to the risk of death had not been previously reported (7-16). It is possible that the association between anemia and mortality observed in this clinical trial was a consequence of selection of patients for SOLVD, and similar results might not pertain in a more...

Anemia was present in 47.7% of 5222 predialysis patients with chronic kidney disease. Prevalence of anemia increased as kidney function decreased. Certain subgroups are at increased risk for anemia.

Venous catheters are associated with an increased risk of all-cause and infection-related mortality among hemodialysis patients.