TY - JOUR T1 - Clinical and subclinical cardiovascular disease and kidney function decline in the elderly. JF - Atherosclerosis Y1 - 2009 A1 - Shlipak, Michael G A1 - Katz, Ronit A1 - Kestenbaum, Bryan A1 - Fried, Linda F A1 - Siscovick, David A1 - Sarnak, Mark J KW - Age Factors KW - Aged KW - Atherosclerosis KW - Cardiovascular Diseases KW - Creatinine KW - Cystatin C KW - Female KW - Glomerular Filtration Rate KW - Heart Failure KW - Humans KW - Kidney KW - Kidney Diseases KW - Linear Models KW - Longitudinal Studies KW - Male KW - Odds Ratio KW - Risk Assessment KW - Risk Factors KW - Time Factors KW - United States AB -

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.

VL - 204 IS - 1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18848325?dopt=Abstract ER -