Kidney function, electrocardiographic findings, and cardiovascular events among older adults.
Chronic kidney disease (CKD) is associated with cardiovascular (CV) disease and mortality. It is not known whether cardiac rhythm disturbances are more prevalent among individuals with CKD or whether resting electrocardiogram findings predict future CV events in the CKD setting. Data were obtained from the Cardiovascular Health Study, a community-based study of adults aged >/=65 yr. After exclusions for prevalent heart disease, atrial fibrillation, implantable pacemaker, or antiarrhythmic medication use, 3238 participants were analyzed. CKD was defined by an estimated GFR <60 ml/min per 1.73 m(2). Outcomes were adjudicated incident heart failure (HF), incident coronary heart disease (CHD), and mortality. Participants with CKD had longer PR and corrected QT intervals compared with those without CKD; however, differences in electrocardiographic markers were explained by traditional CV risk factors and CV medication use. After adjustment for known risk factors, each 10-ms increase in the QRS interval was associated with a 15% greater risk for incident HF (95% confidence interval [CI] 1.04 to 1.27), a 13% greater risk for CHD (95% CI 1.04 to 1.24), and a 17% greater risk for mortality (95% CI 1.09, 1.25) among CKD participants. Each 5% increase in QTI was associated with a 42% (95% CI 1.23 to 1.65), 22% (95% CI 1.07 to 1.40), and 10% (95% CI 0.98 to 1.22) greater risk for HF, CHD, and mortality, respectively. Associations seemed stronger for participants with CKD; however, no significant interactions were detected. Resting electrocardiographic abnormalities are common in CKD and independently predict future clinical CV events in this setting.
Kestenbaum
Bryan
B
Division of Nephrology, Harborview Medical Center, University of Washington, Seattle, WA 98104-2499, USA. brk@u.washington.edu
Rudser
Kyle D
KD
Shlipak
Michael G
MG
Fried
Linda F
LF
Newman
Anne B
AB
Katz
Ronit
R
Sarnak
Mark J
MJ
Seliger
Stephen
S
Stehman-Breen
Catherine
C
Prineas
Ronald
R
Siscovick
David S
DS
D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000209:etiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D002908:Chronic Disease; D003327:Coronary Disease / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D018570:Risk Assessment