Global Cardiovascular and Renal Outcomes of Reduced GFR
Authors: Thomas Bernadette , Matsushita Kunihiro , Abate Kalkidan Hassen , Al-Aly Ziyad , Ärnlöv Johan , Asayama Kei , Atkins Robert , Badawi Alaa , Ballew Shoshana H. , Banerjee Amitava , Barregård Lars , Barrett-Connor Elizabeth , Basu Sanjay , Bello Aminu K. , Bensenor Isabela , Bergstrom Jaclyn , Bikbov Boris , Blosser Christopher , Brenner Hermann , Carrero Juan-Jesus , Chadban Steve , Cirillo Massimo , Cortinovis Monica , Courville Karen , Dandona Lalit , Dandona Rakhi , Estep Kara , Fernandes João , Fischer Florian , Fox Caroline , Gansevoort Ron T. , Gona Philimon N. , Gutierrez Orlando M. , Hamidi Samer , Hanson Sarah Wulf , Himmelfarb Jonathan , Jassal Simerjot K. , Jee Sun Ha , Jha Vivekanand , Jimenez-Corona Aida , Jonas Jost B. , Kengne Andre Pascal , Khader Yousef , Khang Young-Ho , Kim Yun Jin , Klein Barbara , Klein Ronald , Kokubo Yoshihiro , Kolte Dhaval , Lee Kristine , Levey Andrew S. , Li Yongmei , Lotufo Paulo , El Razek Hassan Magdy Abd , Mendoza Walter , Metoki Hirohito , Mok Yejin , Muraki Isao , Muntner Paul M. , Noda Hiroyuki , Ohkubo Takayoshi , Ortiz Alberto , Perico Norberto , Polkinghorne Kevan , Al-Radaddi Rajaa , Remuzzi Giuseppe , Roth Gregory , Rothenbacher Dietrich , Satoh Michihiro , Saum Kai-Uwe , Sawhney Monika , Schöttker Ben , Shankar Anoop , Shlipak Michael , Silva Diego Augusto Santos , Toyoshima Hideaki , Ukwaja Kingsley , Umesawa Mitsumasa , Vollset Stein Emil , Warnock David G. , Werdecker Andrea , Yamagishi Kazumasa , Yano Yuichiro , Yonemoto Naohiro , Zaki Maysaa El Sayed , Naghavi Mohsen , Forouzanfar Mohammad H. , Murray Christopher J.L. , Coresh Josef , Vos Theo ,   on behalf of the Global Burden of Disease 2013 GFR Collaborators,   CKD Prognosis Consortium,   Global Burden of Disease Genitourinary Expert Group
Published: April 2017

The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.