title: The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD.
abstract: BACKGROUND
  Chronic kidney disease is associated with increased risk for cardiovascular disease and mortality. Both traditional and nontraditional cardiovascular disease risk factors may contribute.
  
  
  METHODS
  Cohort.
  
  
  METHODS
  Community-based adult population of the Atherosclerosis Risk in Communities and Cardiovascular Health Studies with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m(2).
  
  
  METHODS
  Nontraditional cardiovascular disease risk factors, including body mass index, diastolic blood pressure, and triglyceride, albumin, uric acid, fibrinogen, C-reactive protein, and hemoglobin levels.
  
  
  RESULTS
  Composite of myocardial infarction, stroke, and all-cause mortality. Secondary outcomes included individual components of the composite.
  
  
  RESULTS
  Of 1,678 individuals with decreased eGFR (mean, 51.1 +/- 8.5 mL/min/1.73 m(2)), 891 (53%) reached the composite end point during a median follow-up of 108 months; 23% had a cardiac event, 45% died, and 14% experienced a stroke. Serum albumin level less than 3.9 g/dL (hazard ratio, 0.68 for every 0.3-g/dL decrease; 95% confidence interval, 0.60 to 0.77), increased serum triglyceride level (hazard ratio, 1.07 for every 50-mg/dL increase; 95% confidence interval, 1.02 to 1.12), C-reactive protein level (hazard ratio, 1.15 per log-unit increase; 95% confidence interval, 1.07 to 1.24), and fibrinogen level (hazard ratio, 1.12 per 50-mg/dL increase; 95% confidence interval, 1.07 to 1.18) independently predicted composite events. Both decreased (<14.5 g/dL) and increased (>14.5 g/dL) hemoglobin levels predicted composite events. Serum albumin level less than 3.9 g/dL and increased serum fibrinogen level independently predicted cardiac events. For serum albumin and hemoglobin levels, the relationship with composite and mortality outcomes was nonlinear (P < 0.001).
  
  
  CONCLUSIONS
  Single assessment of eGFR. No albuminuria data.
  
  
  CONCLUSIONS
  Several nontraditional cardiovascular disease risk factors predict adverse outcomes in individuals with stage 3 to 4 chronic kidney disease. The relationship between risk factors and outcomes is often nonlinear.
authors.affiliation: Division of Nephrology, Tufts-New England Medical Center, Boston, MA 02111, USA. dweiner@tufts-nemc.org
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Essam F
authors.initials: EF
authors.lastname: Elsayed
authors.forename: John L
authors.initials: JL
authors.lastname: Griffith
authors.forename: Deeb N
authors.initials: DN
authors.lastname: Salem
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000209:etiology* / Q000503:physiopathology*; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin; D014280:Triglycerides; D014527:Uric Acid; D005340:Fibrinogen; D002097:C-Reactive Protein