04943nas a2201321   4500000000100000008004100001653001100042653001700053653002000070653002000090653002800110653001800138653003100156653001100187100002400198700001200222700001700234700002100251700001600272700002000288700001800308700001800326700002500344700001500369700001700384700001900401700002100420700001900441700001900460700002100479700001900500700002200519700001800541700001300559700002100572700002300593700001400616700001100630700002200641700001900663700001700682700001900699700001600718700001800734700001600752700002000768700002000788700002900808700001600837700002100853700002100874700001700895700002400912700002000936700002300956700001800979700002200997700002001019700001501039700002001054700002001074700001701094700001901111700001801130700002201148700001701170700001701187700002401204700002001228700002401248700001801272700001201290700001801302700001701320700001701337700001701354700001701371700001501388700001701403700001701420700002001437700001601457700001701473700001801490700001801508700002001526700002301546700002101569700002101590700001701611700002601628700002001654700001701674700001901691700001801710700002001728700001601748700002001764700002201784700001801806700002101824700002301845700001801868700001601886700005201902700002901954700005601983245006102039300001402100490000702114520148602121022001403607       2017                            d10aHumans10aRisk Factors10aRisk Assessment10aKidney Diseases10aCardiovascular Diseases10aGlobal Health10aGlomerular Filtration Rate10aKidney1 aMatsushita Kunihiro1 aJee Sun1 aCoresh Josef1 aBanerjee Amitava1 aBasu Sanjay1 aCirillo Massimo1 aDandona Lalit1 aDandona Rakhi1 aForouzanfar Mohammad1 aJonas Jost1 aKengne Andre1 aKhang Young-Ho1 aKokubo Yoshihiro1 aMendoza Walter1 aNaghavi Mohsen1 aOhkubo Takayoshi1 aSawhney Monika1 aToyoshima Hideaki1 aVollset Stein1 aVos Theo1 aYonemoto Naohiro1 aMurray Christopher1 aMok Yejin1 aJha V.1 aThomas Bernadette1 aAbate Kalkidan1 aAl-Aly Ziyad1 aÄrnlöv Johan1 aAsayama Kei1 aAtkins Robert1 aBadawi Alaa1 aBallew Shoshana1 aBarregård Lars1 aBarrett-Connor Elizabeth1 aBello Aminu1 aBensenor Isabela1 aBergstrom Jaclyn1 aBikbov Boris1 aBlosser Christopher1 aBrenner Hermann1 aCarrero Juan-Jesus1 aChadban Steve1 aCortinovis Monica1 aCourville Karen1 aEstep Kara1 aFernandes João1 aFischer Florian1 aFox Caroline1 aGansevoort Ron1 aGona Philimon1 aGutierrez Orlando1 aHamidi Samer1 aHanson Sarah1 aHimmelfarb Jonathan1 aJassal Simerjot1 aJimenez-Corona Aida1 aKhader Yousef1 aKim Yun1 aKlein Barbara1 aKlein Ronald1 aKolte Dhaval1 aLee Kristine1 aLevey Andrew1 aLi Yongmei1 aLotufo Paulo1 aRazek Hassan1 aMetoki Hirohito1 aMuraki Isao1 aMuntner Paul1 aNoda Hiroyuki1 aOrtiz Alberto1 aPerico Norberto1 aPolkinghorne Kevan1 aAl-Radaddi Rajaa1 aRemuzzi Giuseppe1 aRoth Gregory1 aRothenbacher Dietrich1 aSatoh Michihiro1 aSaum Kai-Uwe1 aSchöttker Ben1 aShankar Anoop1 aShlipak Michael1 aSilva Diego1 aUkwaja Kingsley1 aUmesawa Mitsumasa1 aWarnock David1 aWerdecker Andrea1 aYamagishi Kazumasa1 aYano Yuichiro1 aZaki Maysaa1 aGlobal Burden of Disease 2013 GFR Collaborators1 aCKD Prognosis Consortium1 aGlobal Burden of Disease Genitourinary Expert Group00aGlobal Cardiovascular and Renal Outcomes of Reduced GFR.  a2167-21790 v283 a<p>
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.
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