Estimated Glomerular Filtration Rate and the Risk of Major Vascular Events and All-Cause Mortality A Meta-Analysis 英文参考文献.docVIP

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Estimated Glomerular Filtration Rate and the Risk of Major Vascular Events and All-Cause Mortality A Meta-Analysis 英文参考文献.doc

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Estimated Glomerular Filtration Rate and the Risk of Major Vascular Events and All-Cause Mortality A Meta-Analysis 英文参考文献

EstimatedGlomerularFiltrationRateandtheRiskof MajorVascularEventsandAll-CauseMortality:AMeta- Analysis MarionMafham1,JonathanEmberson1,MartinJ.Landray1,Chi-PangWen2,ColinBaigent1* 1ClinicalTrialServiceUnitandEpidemiologicalStudiesUnit(CTSU),UniversityofOxford,Oxford,UnitedKingdom,2CenterforHealthPolicyResearchandDevelopment, NationalHealthResearchInstitutes,Zhunan,Taiwan Abstract Background:Lowerestimatedglomerularfiltrationrate(eGFR)hasbeenassociatedwithanincreasedriskofmajorvascular events (MVEs) and death, but differences in methodology make between-study comparisons difficult. We used a novel methodtosummarisethepublishedresults. Methods and Findings: Studies assessing the relationship between baseline eGFR and subsequent MVEs or all cause mortalitywereidentifiedusingPubmed.Thosewhichinvolvedatleast500individuals,plannedatleast1yearoffollow-up, reportedage andsexadjustedrelativerisks,andprovidedthemeaneGFRineachcategory(orsufficientinformationto allowitsestimation)wereincluded.Totakeaccountofdifferencesinunderlyingriskbetweenstudies,proportionalwithin- study differences in eGFR (rather than absolute eGFR values) were related to risk. Fifty studies (2 million participants) assessing MVEs and 67 studies (5 million participants) assessing all cause mortality were eligible. There was an inverse relationshipbetweenlowereGFRandtheriskofMVEsandofdeath.Instudiesamongpeoplewithoutpriorvasculardisease, a30%lowereGFRlevelwasonaverageassociatedwitha29%(SE0.2%)increaseintheriskofaMVEanda31%(SE0.2%) increaseintheriskofdeathfromanycause.Instudiesamongpeoplewithpriorvasculardisease,theseestimateswere26% (SE 1.0%) and 23% (SE 0.2%) respectively. While there was substantial statistical heterogeneity between the results of individualstudies,a30%lowereGFRwasconsistentlyassociatedwitha20-30%higherriskofbothoutcomes,irrespectiveof priorhistoryofvasculardiseaseorstudydesign. Conclusions: Lower eGFR was consistently associated with a moderate increase in the risk of death and MVEs. I