Objective To determine the association between baseline kidney function and subsequent all-cause mortality.Design and setting A general population-based cohort study from rural Uganda.Participants People aged 18 years and above with measured baseline estimated glomerular filtration rate (eGFR), recruited from survey rounds in 2011textendash2012 or 2014textendash2015 and followed up to March 2019.Outcome measure The primary outcome was all-cause mortality, identified through reports from community health workers and verified by verbal autopsy. The association between baseline eGFR category and mortality was determined using multivariable Cox regression.Results Of 5812 participants in both rounds, we included 5678 (97.7 participants with kidney function and mortality data; the median age was 36 years (IQR 24textendash50), 60.7 10.3 9.8positive and 1.5up of 5.0 years (IQR 3.7textendash6.0) there were 140 deaths. In age-adjusted and sex-adjusted analyses, eGFR lt;45 mL/min/1.73 m2 at baseline was associated with a 5.97 (95.55 to 13.98) increased risk of mortality compared with those with baseline eGFR gt;90 mL/min/1.73 m2. After inclusion of additional confounders (HIV, body mass index, diabetes, hypertension, alcohol and smoking status) into the model, eGFR lt;45 mL/min/1.73 m2 at baseline remained strongly associated with mortality (HR 6.12, 95.27 to 16.45), although the sample size fell to 3102. Test for trend showed strong evidence (plt;0.001) that the rate of mortality increased progressively as the category of baseline kidney function decreased. When very high eGFR was included as a separate category in age-adjusted and sex-adjusted analyses, baseline eGFR >=120 mL/min/1.73 m2 was associated with increased risk of mortality (HR 2.68, 95.47 to 4.87) compared with the reference category of 90textendash119 mL/min/1.73 m2.Conclusion In a prospective cohort in rural Uganda we found that impaired baseline kidney function was associated with subsequently increased total mortality. Improved understanding of the determinants of kidney disease and its progression is needed in order to inform interventions for prevention and treatment.Data are available upon reasonable request. Owing to data protection concerns, there are restrictions on access to the underlying data. The GPC database contains 25 years of longitudinal data sets on demographics and disease surveillance. All data (census, survey and laboratory) generated through the cohort are stored and curated at the MRC/UVRI and the LSHTM Research Unit. Data access for specific research purposes is possible and has been granted previously. For any data access enquiries, you may contact the director, MRC/UVRI and the LSHTM Research Unit or by email to mrc@mrcuganda.org or the corresponding author.
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CORE (COnnecting REpositories)