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Rapid kidney function decline and mortality risk in older adults.
Tuesday,2012-11-06 12:10 America/Los_Angeles — eenright
| Title | Rapid kidney function decline and mortality risk in older adults. |
| Publication Type | Journal Article |
| Year of Publication | 2008 |
| Authors | Rifkin, DE, Shlipak, MG, Katz, R, Fried, LF, Siscovick, D, Chonchol, M, Newman, AB, Sarnak, MJ |
| Journal | Arch Intern Med |
| Volume | 168 |
| Issue | 20 |
| Pagination | 2212-8 |
| Date Published | 2008 Nov 10 |
| ISSN | 1538-3679 |
| Keywords | Aged, Cardiovascular Diseases, Creatinine, Cystatins, Female, Glomerular Filtration Rate, Humans, Kidney, Male, Mortality |
| Abstract | <p><b>BACKGROUND: </b>Impaired kidney function is associated with increased mortality risk in older adults. It remains unknown, however, whether longitudinal declines in kidney function are independently associated with increased cardiovascular and all-cause mortality in older adults.</p><p><b>METHODS: </b>The Cardiovascular Health Study evaluated a cohort of community-dwelling older adults enrolled from 1989 to 1993 in 4 US communities with follow-up through 2005. Among 4380 participants, the slope of annual decline in estimated glomerular filtration rate (eGFR) was estimated using both serum creatinine (eGFR(creat)) and cystatin C (eGFR(cys)) rates, which were measured at baseline, year 3, and year 7 of follow-up. Rapid decline in eGFR was defined as a loss greater than 3 mL/min/1.73 m(2) per year, and cardiovascular and all-cause mortality were assessed over a mean of 9.9 years of follow-up.</p><p><b>RESULTS: </b>Mean (SD) levels of creatinine and cystatin C were 0.93 (0.30) mg/dL and 1.03 (0.25) mg/L, respectively; mean (SD) eGFR(creat) and eGFR(cys) were 79 (23) mL/min/1.73 m(2) and 79 (19) mL/min/1.73 m(2), respectively. Individuals with rapid decline measured by eGFR(creat) (n = 714; 16%) had increased risk of cardiovascular (adjusted hazard ratio [AHR], 1.70; 95% confidence interval [CI], 1.40-2.06) and all-cause (AHR, 1.73; 95% CI, 1.54-1.94) mortality. Individuals with rapid decline measured by eGFR(cys) (n = 1083; 25%) also had increased risk of cardiovascular (AHR, 1.53; 95% CI, 1.29-1.80) and all-cause (AHR, 1.53; 95% CI, 1.38-1.69) mortality. The association of rapid decline in eGFR with elevated mortality risk did not differ across subgroups based on baseline kidney function, age, sex, race, or prevalent coronary heart disease.</p><p><b>CONCLUSION: </b>Rapid decline in eGFR is associated with an increased risk of cardiovascular and all-cause mortality in older adults, independent of baseline eGFR and other demographic variables.</p> |
| DOI | 10.1001/archinte.168.20.2212 |
| Alternate Journal | Arch Intern Med |
| PubMed ID | 19001197 |
| PubMed Central ID | PMC2879064 |
| Grant List | R01-AG-027002 / AG / NIA NIH HHS / United States R01 AG027002-01 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States K24DK078204 / DK / NIDDK NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States K24 DK078204 / DK / NIDDK NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States N01-HC-55222 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States R01 AG027002 / AG / NIA NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States |