Hazards of poor renal function are independent of diabetes and hypertensionBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6602 (Published 03 October 2012) Cite this as: BMJ 2012;345:e6602
Poor renal function is a risk factor for death, cardiovascular death, and end stage renal disease. Risks rise as estimated glomerular filtration rates fall. They rise faster in adults with proteinuria.
These hazards are about the same for people with and without diabetes, according to a new meta-analysis. Although people with diabetes had higher absolute mortality than people without, the relative hazards associated with a low glomerular filtration rate or proteinuria were about the same in both patient groups. Renal disease is an important risk factor, whether or not you have diabetes, say the authors.
A second meta-analysis did a similar investigation that compared adults with and without hypertension. If anything, the hazards of poor renal function looked worse for adults with normal blood pressure. Low glomerular filtration rate and proteinuria were more strongly associated with death in adults without hypertension than in adults with hypertension. The association between low glomerular filtration rate or proteinuria and end stage renal disease looked about the same in both groups.
Both studies analysed data from more than 40 observational cohorts and more than one million people. The results tell us that simple measures of kidney health are good predictors of important outcomes regardless of the presence of hypertension or diabetes, says a linked comment (doi:10.1016/S0140-6736(12)61300-2). They confirm that even moderate impairment of kidney function is a risk factor for death from cardiovascular disease in otherwise healthy people. These studies can’t yet tell us precisely who we should screen with these simple measures or how best to manage those we identify as abnormal.
Cite this as: BMJ 2012;345:e6602