Renal function and heart failure risk in older black and white individuals: the Health, Aging, and Body Composition Study.
BACKGROUND
Chronic kidney disease is a risk factor for heart failure, an association that may be particularly important in blacks who are disproportionately affected by both processes. Our objective was to determine whether the association of chronic kidney disease with incident heart failure differs between blacks and whites.


METHODS
The study population comprised participants in the Health, Aging, and Body Composition Study without a diagnosis of heart failure (1124 black and 1676 white community-dwelling older persons). The main predictors were quintiles of cystatin C and creatinine concentrations and estimated glomerular filtration rate. The main outcome measure was incident heart failure.


RESULTS
Over a mean 5.7 years, 200 participants developed heart failure. High concentrations of cystatin C and low estimated glomerular filtration rate were each associated with heart failure, but the magnitude was greater for blacks than for whites (cystatin C concentration: adjusted hazard ratio for quintile 5 [> or =1.18 mg/dL] vs quintile 1 [<0.84 mg/dL] was 3.0 [95% confidence interval 1.4-6.5] in blacks and 1.4 [95% confidence interval, 0.8-2.5] in whites; estimated glomerular filtration rate: adjusted hazard ratio for quintile 5 (<59.2 mL/min) vs quintile 1 (>86.7 mL/min) was 2.7 [95% confidence interval, 1.4-4.9] in blacks and 1.8 [95% confidence interval, 0.9-3.6] in whites). For cystatin C, this association was observed at more modest decrements in kidney function among blacks as well. The population attributable risk of heart failure was 47% for blacks with moderate or high concentrations of cystatin C (> or =0.94 mg/dL) (56% prevalence) but only 5% among whites (64% prevalence).


CONCLUSIONS
The association of kidney dysfunction with heart failure appears stronger in blacks than for whites, particularly when cystatin C is used to measure kidney function.
Bibbins-Domingo
Kirsten
K
Division of General Internal Medicine, San Francisco General Hospital, CA 94143-1364, USA. bbinsk@medicine.ucsf.edu
Chertow
Glenn M
GM
Fried
Linda F
LF
Odden
Michelle C
MC
Newman
Anne B
AB
Kritchevsky
Stephen B
SB
Harris
Tamara B
TB
Satterfield
Suzanne
S
Cummings
Steven R
SR
Shlipak
Michael G
MG
D000368:Aged; D015415:Biomarkers / Q000097:blood; D044383:Black People; D002908:Chronic Disease; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000453:epidemiology*; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D044465:White People; D001741:Black or African American
D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine