The National Kidney Foundation lists kidney failure, complications of reduced kidney function and heart disease as outcomes of chronic kidney disease3Guideline · 2003National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification.racial or ethnic minority status), detecting kidney damage by measuring the albumin-creatinine ratio in untimed ("spot") urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney…Ann Intern Med. It advises checking people at higher risk: those with diabetes, high blood pressure, a family history, or age over 603Guideline · 2003National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification.racial or ethnic minority status), detecting kidney damage by measuring the albumin-creatinine ratio in untimed ("spot") urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney…Ann Intern Med. KDIGO also names heart disease and early death as outcomes of the condition4Guideline · 2005Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO).Kidney disease treatment by dialysis and transplantation should be noted. Simple, uniform classifications of CKD by cause and by risks for kidney disease progression and CVD should be developed.Kidney Int.
What the studies show
A pooled analysis of 114 cohorts (over 27 million people, average follow-up 4.8 years) linked lower eGFR to higher risk of all 10 outcomes studied, including death, heart attack, stroke, heart failure and hospitalization. This held even in the mildest categories1Meta-analysis · 2023 · 753 peopleEstimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis.In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.JAMA.
In one example from that analysis, hospitalizations were 161 versus 79 per 1,000 person-years for eGFR 45 to 59 versus 90 to 104. That is 22 extra per 1,000 person-years after adjustment1Meta-analysis · 2023 · 753 peopleEstimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis.In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.JAMA. Like all the figures here, it compares groups, so one person's gain or loss depends on their starting risk.
A pooled analysis of general-population cohorts (over 105,000 people with urine albumin data) found no added risk of death between eGFR 75 and 105. Risk rose below that: about 18% higher at 60, 57% higher at 45, and over 3 times as high at 15, compared with eGFR 952Meta-analysis · 2010 · 1,128,310 peopleAssociation of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.eGFR less than 60 mL/min/1.73 m(2) and ACR 1.1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.Lancet. Heart-related death showed similar patterns2Meta-analysis · 2010 · 1,128,310 peopleAssociation of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.eGFR less than 60 mL/min/1.73 m(2) and ACR 1.1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.Lancet.
A study following 1.1 million adults for a median of 2.8 years found that after adjustment, death risk was about 1.2 times as high at eGFR 45 to 59 and 5.9 times as high below 15. Heart disease events were 1.4 times as likely at 45 to 59 and 3.4 times as likely below 157Observational study · 2004 · 1,120,295 peopleChronic kidney disease and the risks of death, cardiovascular events, and hospitalization.An independent, graded association was observed between a reduced estimated GFR and the risk of death, cardiovascular events, and hospitalization in a large, community-based population. These findings highlight the clinical and public health importance of chronic renal insufficiency.N Engl J Med.
A review of 39 studies (1.37 million people) found reduced kidney function raised death risk in most cohorts. The link weakened by a median of 17% after adjusting for other risk factors but stayed in 71% of cohorts6Meta-analysis · 2006 · 1,371,990 peopleChronic kidney disease and mortality risk: a systematic review.This review supports current guidelines that identify individuals with CKD as being at high risk for cardiovascular mortality. Determining which interventions best offset this risk remains a health priority.J Am Soc Nephrol.
Among 1,268 adults aged 65 and older with eGFR below 60, 61% died over 9.7 years, while 5% reached kidney failure. They were 6 times as likely to die of heart causes as to reach kidney failure9Observational study · 2011 · 1,268 peopleChronic kidney disease and the risk of end-stage renal disease versus death.Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.J Gen Intern Med.
Faster eGFR decline over time was linked to the highest death risk8Observational study · 2023 · 62 peopleTrajectories of kidney function and risk of mortality.Sex, hypertension, diabetes and CVD were identified as trajectory membership determinants. Having fast eGFR decline was associated with the highest risk of all-cause mortality, highlighting the need for extensive monitoring and prevention of kidney function decline in individuals at risk of having fast eGFR decline.Int J Epidemiol.
Key studies
Study
Who
What it found
Pooled cohort analysis, 20231Meta-analysis · 2023 · 753 peopleEstimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis.In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations.JAMA
27 million adults, 114 cohorts
Lower eGFR linked to all 10 bad outcomes
Pooled analysis, 20102Meta-analysis · 2010 · 1,128,310 peopleAssociation of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.eGFR less than 60 mL/min/1.73 m(2) and ACR 1.1 mg/mmol (10 mg/g) or more are independent predictors of mortality risk in the general population. This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease.Lancet
105,872 people, general population
Death risk rose below eGFR 75
Study following people, 20047Observational study · 2004 · 1,120,295 peopleChronic kidney disease and the risks of death, cardiovascular events, and hospitalization.An independent, graded association was observed between a reduced estimated GFR and the risk of death, cardiovascular events, and hospitalization in a large, community-based population. These findings highlight the clinical and public health importance of chronic renal insufficiency.N Engl J Med
1.1 million adults
Graded rise in death and heart events
Review of 39 studies, 20066Meta-analysis · 2006 · 1,371,990 peopleChronic kidney disease and mortality risk: a systematic review.This review supports current guidelines that identify individuals with CKD as being at high risk for cardiovascular mortality. Determining which interventions best offset this risk remains a health priority.J Am Soc Nephrol
1.37 million people
Death risk higher in most cohorts
Study following people, 20119Observational study · 2011 · 1,268 peopleChronic kidney disease and the risk of end-stage renal disease versus death.Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.J Gen Intern Med
1,268 adults 65+ with low eGFR
Death far more likely than kidney failure
What we don't know
Whether raising eGFR lowers these risks. These studies show links, and the best way to offset the risk is still a research priority6Meta-analysis · 2006 · 1,371,990 peopleChronic kidney disease and mortality risk: a systematic review.This review supports current guidelines that identify individuals with CKD as being at high risk for cardiovascular mortality. Determining which interventions best offset this risk remains a health priority.J Am Soc Nephrol.
How well the group figures predict one person's outcome.
Written by AI from the studies listed, without review by a clinician, and graded with the GRADE method. It can be wrong, so check the studies it cites. Education, not medical advice.