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Filtration Markers as Predictors of ESRD and Mortality: Individual Participant Data Meta-Analysis.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2017 Jan 06; Vol. 12 (1), pp. 69-78. Date of Electronic Publication: 2016 Nov 10. - Publication Year :
- 2017
-
Abstract
- Background and Objectives: Serum β-trace protein (BTP) and β-2 microglobulin (B2M) are associated with risk of ESRD and death in the general population and in populations at high risk for these outcomes (GP/HR) and those with CKD, but results differ among studies.<br />Design, Setting, Participants, & Measurements: We performed an individual patient-level meta-analysis including three GP/HR studies (n=17,903 participants) and three CKD studies (n=5415). We compared associations, risk prediction, and improvement in reclassification of eGFR using BTP (eGFR <subscript>BTP</subscript> ) and B2M (eGFR <subscript>B2M</subscript> ) alone and the average (eGFR <subscript>avg</subscript> ) of eGFR <subscript>BTP</subscript> , eGFR <subscript>B2M</subscript> , creatinine (eGFR <subscript>cr</subscript> ), and cystatin C (eGFR <subscript>cys</subscript> ), to eGFR <subscript>cr</subscript> , eGFR <subscript>cys</subscript> , and their combination (eGFR <subscript>cr-cys</subscript> ) for ESRD (2075 events) and death (7275 events).<br />Results: Mean (SD) follow up times for ESRD and mortality for GP/HR and CKD studies were 13 (4), 6.2 (3.2), 14 (5), and 7.5 (3.9) years, respectively. Compared with eGFR <subscript>cr</subscript> , eGFR <subscript>BTP</subscript> and eGFR <subscript>B2M</subscript> improved risk associations and modestly improved prediction for ESRD and death even after adjustment for established risk factors. eGFR <subscript>avg</subscript> provided the most consistent improvement in associations and prediction across both outcomes and populations. Assessment of heterogeneity did not yield clinically relevant differences. For ESRD, addition of albuminuria substantially attenuated the improvement in risk prediction and risk classification with novel filtration markers. For mortality, addition of albuminuria did not affect the improvement in risk prediction with the use of novel markers, but lessened improvement in risk classification, especially for the CKD cohort.<br />Conclusions: These markers do not provide substantial additional prognostic information to eGFR <subscript>cr</subscript> and albuminuria, but may be appropriate in circumstances where eGFR <subscript>cr</subscript> is not accurate or albuminuria is not available. Educational efforts to increase measurement of albuminuria in clinical practice may be more cost-effective than measurement of BTP and B2M for improving prognostic information.<br /> (Copyright © 2016 by the American Society of Nephrology.)
- Subjects :
- Adult
Aged
Albuminuria urine
Biomarkers blood
Creatinine blood
Cystatin C blood
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic physiopathology
Male
Middle Aged
Predictive Value of Tests
Risk Assessment
Risk Factors
Glomerular Filtration Rate
Intramolecular Oxidoreductases blood
Kidney Failure, Chronic blood
Kidney Failure, Chronic epidemiology
Lipocalins blood
Mortality
beta 2-Microglobulin blood
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 12
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 28062677
- Full Text :
- https://doi.org/10.2215/CJN.03660316