TY - JOUR T1 - Kidney function and mortality in octogenarians: Cardiovascular Health Study All Stars. JF - J Am Geriatr Soc Y1 - 2012 A1 - Shastri, Shani A1 - Katz, Ronit A1 - Rifkin, Dena E A1 - Fried, Linda F A1 - Odden, Michelle C A1 - Peralta, Carmen A A1 - Chonchol, Michel A1 - Siscovick, David A1 - Shlipak, Michael G A1 - Newman, Anne B A1 - Sarnak, Mark J KW - Aged, 80 and over KW - Analysis of Variance KW - Cardiovascular Diseases KW - Chi-Square Distribution KW - Creatinine KW - Cystatin C KW - Diabetes Mellitus KW - Female KW - Glomerular Filtration Rate KW - Humans KW - Hypertension KW - Kidney Diseases KW - Male KW - Prevalence KW - Proportional Hazards Models KW - Retrospective Studies KW - Risk Factors KW - United States AB -

OBJECTIVES: To examine the association between kidney function and all-cause mortality in octogenarians.

DESIGN: Retrospective analysis of prospectively collected data.

SETTING: Community.

PARTICIPANTS: Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study (CHS) All Stars participants.

MEASUREMENTS: Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (eGFR(CR) ) and cystatin C one-variable (eGFR(CYS) ) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models.

RESULTS: Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between eGFR(CR) and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m(2) ), the highest (≥ 75 mL/min per 1.73 m(2) ) and lowest (≤ 43 mL/min per 1.73 m(2) ) quintiles of eGFR(CR) were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between eGFR(CYS) and all-cause mortality was linear in those with eGFR(CYS) of less than 60 mL/min per 1.73 m(2) , and in the multivariate analyses, the lowest quintile of eGFR(CYS) (<52 mL/min per 1.73 m(2) ) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m(2) ).

CONCLUSION: Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFR(CR) and all-cause mortality differed from that observed with eGFR(CYS) ; the relationship was U-shaped for eGFR(CR) , whereas the risk was primarily present in the lowest quintile for eGFR(CYS) .

VL - 60 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22724391?dopt=Abstract ER -