title: Kidney function as a predictor of noncardiovascular mortality.
abstract: Chronic kidney disease is associated with a higher risk for cardiovascular mortality, as well as all-cause mortality. Whether chronic kidney disease is a predictor of noncardiovascular mortality is less clear. To further explore the latter, the association of kidney function with total noncardiovascular mortality and cause-specific mortality was assessed in the Cardiovascular Health Study, a community-based cohort of older individuals. Kidney disease was assessed using cystatin C and estimated GFR in 4637 participants in 1992 to 1993. Participants were followed until June 30, 2001. Deaths were adjudicated as cardiovascular or noncardiovascular disease by committee, and an underlying cause of death was assigned. The associations of kidney function with total noncardiovascular mortality and cause-specific mortality were analyzed by proportional hazards regression. Noncardiovascular mortality rates increased with higher cystatin C quartiles (16.8, 17.1, 21.6, and 50.0 per 1000 person-years). The association of cystatin C with noncardiovascular mortality persisted after adjustment for demographic factors; the presence of diabetes, C-reactive protein, hemoglobin, and prevalent cardiovascular disease; and measures of atherosclerosis (hazard ratio 1.69; 95% confidence interval 1.33 to 2.15, for the fourth quartile versus the first quartile). Results for estimated GFR were similar. The risk for noncardiac deaths attributed to pulmonary disease, infection, cancer, and other causes was similarly associated with cystatin C levels. Kidney function predicts noncardiovascular mortality from multiple causes in the elderly. Further research is needed to understand the mechanisms and evaluate interventions to reduce the high mortality rate in chronic kidney disease.
authors.affiliation: VA Pittsburgh Healthcare System and Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15240, USA. linda.fried@med.va.gov
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Paulo H M
authors.initials: PH
authors.lastname: Chaves
authors.forename: Nancy Swords
authors.initials: NS
authors.lastname: Jenny
authors.forename: Catherine
authors.initials: C
authors.lastname: Stehman-Breen
authors.forename: Dan
authors.initials: D
authors.lastname: Gillen
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Bleyer
authors.forename: Calvin
authors.initials: C
authors.lastname: Hirsch
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003404:Creatinine / Q000032:analysis / Q000378:metabolism*; D055316:Cystatin C; D015891:Cystatins / Q000032:analysis*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States
chemical_list: C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine