Highlights
- •After adjusting for the covariates, including albuminura, eGFRcys was significantly associated with all-cause and cardiovascular disease mortality.
- •After adjusting for the covariates, including eGFRcys, albuminura was significantly associated with all-cause and cardiovascular disease mortality.
- •The ROC-plot AUC for all-cause mortality was greater for the eGFRcys than for the eGFRMDRD and eGFRCKD-EPI.
Abstract
Objective
To assess the associations among the estimated glomerular filtration rate (eGFR),
albumin to creatinine ratio (ACR), and all-cause and CVD mortality rate and to compare
the performances of eGFRMDRD, eGFRCKD-EPI, and eGFRcys using receiver operating characteristic (ROC) analysis in Korean adults aged ≥ 50
years.
Methods
Of the 9,260 subjects who participated in the baseline survey of a prospective longitudinal
study conducted in Korea, 9,009 (men: 3,574 (39.7%); women: 5,435 (60.3%)) were included
in this analysis after the exclusion of 217 subjects with missing eGFR and 34 subjects
with missing ACR data.
Main outcome measure
The associations of eGFR and ACR with all-cause and CVD mortality were investigated
using Cox proportional hazards models that included sex, age, waist circumference,
smoking, alcohol intake, degree of physical activity, hypertension, diabetes, systolic
blood pressure, log-HbA1c, total cholesterol, log-triglyceride, log-HDL and log-ACR or eGFR.
Results
After adjustment for covariates, independent associations were found between all-cause
mortality and the eGFRcys (mL/min per 1.73 m2) [HR 1.23, 95% confidence interval (CI) 1.05–1.43 for 60–89 vs. ≥ 90; HR 1.87, 95%
CI 1.49–2.34 for 45–59 vs. ≥ 90; HR 2.38, 95% CI 1.77–3.20 for 30–44 vs. ≥ 90; HR
2.82, 95% CI 1.89–4.23 for <30 vs. ≥ 90] and ACR (μg/mg creatinine) [HR 1.09, 95%
CI 0.88–1.34 for Q2 vs. Q1; HR 1.34, 95% CI 1.10–1.63 for Q3 vs. Q1; HR 1.49, 95%
CI 1.22–1.81 for Q4 vs. Q1]. In addition, independent associations of CVD mortality
with the eGFRcys and ACR were significant. In the comparison of eGFR performance, the ROC-plot AUC
for all-cause mortality was significantly greater for the eGFRcys than for the eGFRMDRD and eGFRCKD-EPI.
Conclusion
The eGFRcys and ACR were associated independently with all-cause and CVD mortality after adjustment
for covariates, including the eGFRcys and ACR. In addition, the ROC-plot AUC for all-cause mortality was greater for the
eGFRcys than for the eGFRMDRD and eGFRCKD-EPI in Korean adults aged ≥ 50 years.
Keywords
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Article info
Publication history
Published online: October 31, 2020
Accepted:
October 26,
2020
Received in revised form:
August 25,
2020
Received:
May 12,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
