03044nas a2200445 4500008004100000022001400041245009600055210006900151260001300220300001200233490000800245520184200253653001602095653000902111653002002120653002802140653001502168653001502183653001102198653003102209653001802240653001102258653001102269653002002280653001802300653002502318653000902343653001502352653002002367653001702387653001702404653001802421100002402439700001602463700002202479700002002501700002102521700002002542856003602562 2009 eng d a1879-148400aClinical and subclinical cardiovascular disease and kidney function decline in the elderly.0 aClinical and subclinical cardiovascular disease and kidney funct c2009 May a298-3030 v2043 a
OBJECTIVE: Kidney function decline in elderly persons may be the result of microvascular atherosclerosis. As a proxy for the renovascular system, we evaluated the association of clinical and subclinical cardiovascular disease (CVD) with kidney function decline.
METHODS: This study included 4380 subjects from the Cardiovascular Health Study, a longitudinal, community-based cohort of persons aged >or=65 from 4 U.S. communities. Creatinine and cystatin C were measured at baseline, year 3, and year 7; eligible subjects had at least two measures. Creatinine-based estimated glomerular filtration rate (eGFR(creat)) was calculated using the MDRD equation. Rapid kidney function decline was defined as an annual eGFR loss >3 mL/min/1.73 m(2). Predictors of rapid kidney decline included prevalent and subclinical measures of CVD.
RESULTS: Mean decline in eGFR(creat) was 0.4+/-2.6/year; 714 (16%) had rapid progression. In multivariate models adjusted for demographics, cardiovascular risk factors, and inflammation, prevalent stroke (OR, 95% CI: 1.55, 1.16-2.08) and heart failure (OR, 95% CI: 1.80, 1.40-2.31) were independent predictors of rapid kidney decline. Among persons without clinical CV, the subclinical disease measures ankle-arm index <0.9 (OR, 95% CI: 1.67, 1.25-2.24), common carotid intima-media thickness (>or=1.14 mm) (OR, 95% CI: 1.52, 1.12-2.06) and internal carotid intima-media thickness (>1.82 mm) (OR, 95% CI: 1.50, 1.12-2.02) had independent associations with rapid kidney function decline. Results were similar using cystatin C.
CONCLUSION: Clinical atherosclerosis and heart failure and subclinical measures of CVD have independent associations with kidney function decline progression in the elderly, suggesting an underlying role of renal atherosclerosis.
10aAge Factors10aAged10aAtherosclerosis10aCardiovascular Diseases10aCreatinine10aCystatin C10aFemale10aGlomerular Filtration Rate10aHeart Failure10aHumans10aKidney10aKidney Diseases10aLinear Models10aLongitudinal Studies10aMale10aOdds Ratio10aRisk Assessment10aRisk Factors10aTime Factors10aUnited States1 aShlipak, Michael, G1 aKatz, Ronit1 aKestenbaum, Bryan1 aFried, Linda, F1 aSiscovick, David1 aSarnak, Mark, J uhttps://chs-nhlbi.org/node/1057