Evidence map›Paper›PMID 23013602›Full record

SynthesisLancet (London, England)2012

Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis.

Caroline S Fox, Kunihiro Matsushita, Mark Woodward, Henk J G Bilo, John Chalmers, Hiddo J Lambers Heerspink, Brian J Lee, Robert M Perkins, Peter Rossing, Toshimi Sairenchi and 8 more

Erratum issued Registry-linked trialOpen access · greenAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Lancet (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT07667517 (Efficacy and Safety of Finerenone for the Early Regression of Albuminuria in Patients With Type 2 Diabetes Mellitus and Chronic Kidney Disease), which is not on this map. Cited by 623 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
623citing papers in PubMed, 7 pooled it
45.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07667517 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Efficacy and Safety of Finerenone for the Early Regression of Albuminuria in Patients With Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

TypeinterventionalSponsorFirst Affiliated Hospital of Zhejiang UniversityRan2026 to 2027Enrolled148ConditionsAlbuminuria, Type 2 Diabetes Mellitus (T2DM), Chronic Kidney DiseasesArmsFinerenone (BAY 94-8862), Placebo
3 · Its place in the literature

Who cites it

623 citing papers in PubMed, 7 syntheses or guidelines pooled it, 1,367 citations in OpenAlex.

  1. Pooled it
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  15. Review
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  18. Article
  19. Recommendations for pre-analytical urine sample handling to allow optimal assessment of albuminuria and proteinuria.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026
    Review
  20. LCN2 Associated With the Bidirectional Cardio-Kidney Link in Patients With Type 2 Diabetes and Cardiovascular-Kidney-Metabolic Syndrome.Medical science monitor : international medical journal of experimental and clinical research · 2026
    Article

563 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors at 15 institutions in 7 countries.

Caroline S FoxNational Heart, Lung, and Blood Institute's Framingham Heart Study, Center for Population Studies Framingham, MA, USA.
Kunihiro Matsushita
Mark Woodward
Henk J G Bilo
John Chalmers
Hiddo J Lambers Heerspink
Brian J Lee
Robert M Perkins
Peter Rossing
Toshimi Sairenchi
Marcello Tonelli
Joseph A Vassalotti
Kazumasa Yamagishi
Josef Coresh
Paul E de Jong
Chi-Pang Wen
Robert G Nelson
Chronic Kidney Disease Prognosis Consortium
Johns Hopkins University · USUniversity of Groningen · NLChina Medical University · TWDokkyo Medical University · JPGeisinger Medical Center · USIsala · NLKaiser Permanente Moanalua Medical Center · USNational Heart Lung and Blood Institute · USNational Institute of Diabetes and Digestive and Kidney Diseases · USNational Kidney Foundation · USSteno Diabetes Center · DKThe George Institute for Global Health · AUUniversity of Alberta · CAUniversity of Sydney · AUUniversity of Tsukuba · JP

Funding

VCID and Stroke in a Bi-racial National CohortU01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CUSHMAN, MARY, HOWARD, GEORGE · 2002 to 2022
$96.0M
THE EPIDEMIOLOGY OF AGE-RELATED OCULAR DISEASEU10EY006594 · NEI · UNIVERSITY OF WISCONSIN-MADISON · PI KLEIN, RONALD · 1987 to 2018
$17.3M
Epidemiology, Pathophysiology and Treatment of Diabetic NephropathyZIADK069062 · NIDDK · NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES · PI NELSON, ROBERT G · 2009 to 2023
$10.1M
Exceptional Survival: Trajectories to Functional Aging (CHS All Stars)R01AG023629 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI NEWMAN, ANNE B. · 2004 to 2016
$9.5M
Framingham Heart Study/FoxZIAHL006094 · NHLBI · NATIONAL HEART, LUNG, AND BLOOD INSTITUTE · PI FOX, CAROLINE · 2010 to 2015
$6.9M
CHS Events Follow-up StudyR01HL080295 · NHLBI · UNIVERSITY OF WASHINGTON · PI PSATY, BRUCE M · 2009 to 2014
$6.3M
Predictors of Alheimers Disease in Mild Cognitive ImpairmentR01AG020098 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI LOPEZ, OSCAR L. · 2002 to 2011
$3.7M
MORTALITY FOLLOW-UP AND ANALYSES OF MEN IN THE MRFITR01HL068140 · NHLBI · UNIVERSITY OF MINNESOTA TWIN CITIES · PI NEATON, JAMES DENNIS · 2001 to 2005
$2.6M
GENDER DIFFERENCES IN OSTEOPOROSISR01AG007181 · NIA · UNIVERSITY OF CALIFORNIA SAN DIEGO · PI BARRETT-CONNOR, ELIZABETH L · 1999 to 2002
$1.6M
CVD Predictors of Cognitive Function Trajectory over 20 YearsR01AG028507 · NIA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI BARRETT-CONNOR, ELIZABETH L · 2007 to 2010
$1.2M
Hormonal trajectories in agingR01AG027058 · NIA · UNIVERSITY OF PENNSYLVANIA · PI CAPPOLA, ANNE R · 2006 to 2009
$1.2M
Novel Risk Factors for Chronic Kidney DiseaseR01DK073217 · NIDDK · UNIVERSITY OF WISCONSIN-MADISON · PI KLEIN, RONALD · 2006 to 2008
$800k
Chief Scientist Office CZH/4/656NEI NIH HHS U10 EY006594NHLBI NIH HHS HHSN268201100005CNHLBI NIH HHS HHSN268201100005GNHLBI NIH HHS HHSN268201100005INHLBI NIH HHS HHSN268201100006CNHLBI NIH HHS HHSN268201100007CNHLBI NIH HHS HHSN268201100007INHLBI NIH HHS HHSN268201100008CNHLBI NIH HHS HHSN268201100008INHLBI NIH HHS HHSN268201100009CNHLBI NIH HHS HHSN268201100009INHLBI NIH HHS HHSN268201100010CNHLBI NIH HHS HHSN268201100011CNHLBI NIH HHS HHSN268201100011INHLBI NIH HHS HHSN268201100012CNHLBI NIH HHS HHSN268201200036CNHLBI NIH HHS N01 HC015103NHLBI NIH HHS N01 HC025195NHLBI NIH HHS N01 HC035129NHLBI NIH HHS N01 HC045133NHLBI NIH HHS N01 HC055222NHLBI NIH HHS N01 HC075150NHLBI NIH HHS N01 HC085079NHLBI NIH HHS N01 HC085086NHLBI NIH HHS N01 HC095159NHLBI NIH HHS N01 HC095169NHLBI NIH HHS R01 HL043232NHLBI NIH HHS R01 HL068140NHLBI NIH HHS R01 HL080295NIA NIH HHS R01 AG007181NIA NIH HHS R01 AG015928NIA NIH HHS R01 AG020098NIA NIH HHS R01 AG023629NIA NIH HHS R01 AG027058NIA NIH HHS R01 AG028507NIDDK NIH HHS K23 DK002904NIDDK NIH HHS K23 DK067303NIDDK NIH HHS R01 DK031801NIDDK NIH HHS R01 DK073217NIDDK NIH HHS U01 DK035073NINDS NIH HHS U01 NS041588
6 · The paper itself

Abstract

backgroundChronic kidney disease is characterised by low estimated glomerular filtration rate (eGFR) and high albuminuria, and is associated with adverse outcomes. Whether these risks are modified by diabetes is unknown.

methodsWe did a meta-analysis of studies selected according to Chronic Kidney Disease Prognosis Consortium criteria. Data transfer and analyses were done between March, 2011, and June, 2012. We used Cox proportional hazards models to estimate the hazard ratios (HR) of mortality and end-stage renal disease (ESRD) associated with eGFR and albuminuria in individuals with and without diabetes.

findingsWe analysed data for 1,024,977 participants (128,505 with diabetes) from 30 general population and high-risk cardiovascular cohorts and 13 chronic kidney disease cohorts. In the combined general population and high-risk cohorts with data for all-cause mortality, 75,306 deaths occurred during a mean follow-up of 8·5 years (SD 5·0). In the 23 studies with data for cardiovascular mortality, 21,237 deaths occurred from cardiovascular disease during a mean follow-up of 9·2 years (SD 4·9). In the general and high-risk cohorts, mortality risks were 1·2-1·9 times higher for participants with diabetes than for those without diabetes across the ranges of eGFR and albumin-to-creatinine ratio (ACR). With fixed eGFR and ACR reference points in the diabetes and no diabetes groups, HR of mortality outcomes according to lower eGFR and higher ACR were much the same in participants with and without diabetes (eg, for all-cause mortality at eGFR 45 mL/min per 1·73 m(2) [vs 95 mL/min per 1·73 m(2)], HR 1·35; 95% CI 1·18-1·55; vs 1·33; 1·19-1·48 and at ACR 30 mg/g [vs 5 mg/g], 1·50; 1·35-1·65 vs 1·52; 1·38-1·67). The overall interactions were not significant. We identified much the same findings for ESRD in the chronic kidney disease cohorts.

interpretationDespite higher risks for mortality and ESRD in diabetes, the relative risks of these outcomes by eGFR and ACR are much the same irrespective of the presence or absence of diabetes, emphasising the importance of kidney disease as a predictor of clinical outcomes.

fundingUS National Kidney Foundation.

Indexed as

AgedAlbuminuriaCardiovascular DiseasesCause of DeathDiabetic NephropathiesFemaleGlomerular Filtration RateHumansKidney Failure, ChronicMaleMiddle AgedRisk Factors

Identifiers

PMID23013602
PMCPMC3771350
OpenAlexW2111663222

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.