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Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals.
Tuesday,2012-11-06 12:06 America/Los_Angeles — eenright
| Title | Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. |
| Publication Type | Journal Article |
| Year of Publication | 2003 |
| Authors | Fried, LF, Shlipak, MG, Crump, C, Bleyer, AJ, Gottdiener, JS, Kronmal, RA, Kuller, LH, Newman, AB |
| Journal | J Am Coll Cardiol |
| Volume | 41 |
| Issue | 8 |
| Pagination | 1364-72 |
| Date Published | 2003 Apr 16 |
| ISSN | 0735-1097 |
| Keywords | Aged, Cardiovascular Diseases, Confidence Intervals, Creatinine, Female, Heart Failure, Humans, Intermittent Claudication, Kidney Failure, Chronic, Male, Odds Ratio, Predictive Value of Tests, Survival Analysis |
| Abstract | <p><b>OBJECTIVES: </b>This study was designed to evaluate the relationship between elevated creatinine levels and cardiovascular events.</p><p><b>BACKGROUND: </b>End-stage renal disease is associated with high cardiovascular morbidity and mortality. The association of mild to moderate renal insufficiency with cardiovascular outcomes remains unclear.</p><p><b>METHODS: </b>We analyzed data from the Cardiovascular Health Study, a prospective population-based study of subjects, aged >65 years, who had a serum creatinine measured at baseline (n = 5,808) and were followed for a median of 7.3 years. Proportional hazards models were used to examine the association of creatinine to all-cause mortality and incident cardiovascular mortality and morbidity. Renal insufficiency was defined as a creatinine level > or =1.5 mg/dl in men or > or =1.3 mg/dl in women.</p><p><b>RESULTS: </b>An elevated creatinine level was present in 648 (11.2%) participants. Subjects with elevated creatinine had higher overall (76.7 vs. 29.5/1,000 years, p < 0.001) and cardiovascular (35.8 vs. 13.0/1,000 years, p < 0.001) mortality than those with normal creatinine levels. They were more likely to develop cardiovascular disease (54.0 vs. 31.8/1,000 years, p < 0.001), stroke (21.1 vs. 11.9/1,000 years, p < 0.001), congestive heart failure (38.7 vs. 17/1,000 years, p < 0.001), and symptomatic peripheral vascular disease (10.6 vs. 3.5/1,000 years, p < 0.001). After adjusting for cardiovascular risk factors and subclinical disease measures, elevated creatinine remained a significant predictor of all-cause and cardiovascular mortality, total cardiovascular disease (CVD), claudication, and congestive heart failure (CHF). A linear increase in risk was observed with increasing creatinine.</p><p><b>CONCLUSIONS: </b>Elevated creatinine levels are common in older adults and are associated with increased risk of mortality, CVD, and CHF. The increased risk is apparent early in renal disease.</p> |
| DOI | 10.1016/s0735-1097(03)00163-3 |
| Alternate Journal | J Am Coll Cardiol |
| PubMed ID | 12706933 |
| Grant List | N01-HC-15103 / HC / NHLBI NIH HHS / United States N01-HC-35129 / HC / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States |