TY - JOUR T1 - Rapid decline of kidney function increases cardiovascular risk in the elderly. JF - J Am Soc Nephrol Y1 - 2009 A1 - Shlipak, Michael G A1 - Katz, Ronit A1 - Kestenbaum, Bryan A1 - Siscovick, David A1 - Fried, Linda A1 - Newman, Anne A1 - Rifkin, Dena A1 - Sarnak, Mark J KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Creatinine KW - Cystatin C KW - Female KW - Glomerular Filtration Rate KW - Heart Failure KW - Humans KW - Longitudinal Studies KW - Male KW - Myocardial Infarction KW - Peripheral Vascular Diseases KW - Renal Insufficiency, Chronic KW - Risk Factors KW - Stroke KW - Time Factors KW - United States AB -

Chronic kidney disease (CKD), defined at a specific time point, is an important risk factor for cardiovascular disease. Whether the rate of kidney function decline contributes additional cardiovascular risk is unknown. In the Cardiovascular Health Study, we compared the associations of changes in kidney function during the first 7 yr with the incidence of heart failure (HF), myocardial infarction (MI), stroke, and peripheral arterial disease (PAD) during the subsequent 8 yr. We defined a rapid decline in cystatin C-based estimated GFR as >3 ml/min per 1.73 m(2)/yr, on the basis of determination at baseline, year 3, and year 7. Among eligible participants, 1083 (24%) had rapid kidney decline. The incidence of each type of cardiovascular event was significantly higher among patients with rapid decline (all P < 0.001). After multivariate adjustment for demographics, cardiovascular disease risk factors, and baseline kidney function, rapid kidney function decline was significantly associated with HF (adjusted hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.13 to 1.53), MI (HR 1.48; 95% CI 1.21 to 1.83), and PAD (HR 1.67; 95% CI 1.02 to 2.75) but not with stroke (HR 1.19; 95% CI 0.97 to 1.45). The association of rapid decline with each outcome did not differ by the presence or absence of CKD. In conclusion, declining kidney function associates with higher risk for HF, MI, and PAD among patients with or without CKD.

VL - 20 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19892934?dopt=Abstract ER -