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Albuminuria, impaired kidney function and cardiovascular outcomes or mortality in the elderly.
Tuesday,2012-11-06 12:19 America/Los_Angeles — eenright
| Title | Albuminuria, impaired kidney function and cardiovascular outcomes or mortality in the elderly. |
| Publication Type | Journal Article |
| Year of Publication | 2010 |
| Authors | Rifkin, DE, Katz, R, Chonchol, M, Fried, LF, Cao, J, de Boer, IH, Siscovick, DS, Shlipak, MG, Sarnak, MJ |
| Journal | Nephrol Dial Transplant |
| Volume | 25 |
| Issue | 5 |
| Pagination | 1560-7 |
| Date Published | 2010 May |
| ISSN | 1460-2385 |
| Keywords | Aged, Albuminuria, Cardiovascular Diseases, Creatinine, Cystatin C, Female, Glomerular Filtration Rate, Heart Failure, Humans, Male, Myocardial Infarction, Risk Factors |
| Abstract | <p><b>BACKGROUND: </b>Kidney disease is a risk factor for mortality and cardiovascular disease in older adults, but the separate and combined effects of albuminuria and cystatin C, a novel marker of glomerular filtration, are not known.</p><p><b>METHODS: </b>We examined associations of these markers with mortality and cardiovascular outcomes during a median follow-up of 8.3 years in 3291 older adults in the Cardiovascular Health Study. Kidney disease was assessed using urinary albumin/creatinine ratio (ACR), cystatin C and Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR). We defined subgroups based on presence of microalbuminuria (MA, ACR > 30 mg/g) and categories of normal kidney function (cystatin C < 1.0 mg/L and eGFR > 60 mL/min/1.73 m(2)); preclinical kidney disease (cystatin C level > 1.0 mg/l but eGFR > 60 mL/min/1.73 m(2)); and chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73 m(2)). Cox proportional hazards models were used to examine associations between these six subgroups and all-cause or cardiovascular mortality, myocardial infarction and heart failure.</p><p><b>RESULTS: </b>One thousand one hundred fifty (34.9%) had normal kidney function (12.2% with MA), 1518 (46.1%) had preclinical kidney disease (17.9% with MA) and 622 (18.9%) had CKD (47% with MA). After adjustment, the presence of either preclinical kidney disease or MA was associated with an over 50% increase in mortality risk; the presence of both was associated with a 2.4-fold mortality risk. Those with CKD and MA were at highest risk, with a nearly 4-fold mortality risk.</p><p><b>CONCLUSION: </b>Elevated cystatin C and albuminuria are common, identify different subsets of the older population, and are independent, graded risk factors for cardiovascular disease and mortality.</p> |
| DOI | 10.1093/ndt/gfp646 |
| Alternate Journal | Nephrol. Dial. Transplant. |
| PubMed ID | 20008829 |
| PubMed Central ID | PMC3307251 |
| Grant List | R01-AG-027002 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI 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 |