Mortality risks for all causes and cardiovascular diseases and reduced GFR in a middle-aged working population in Taiwan.
BACKGROUND
Effects of decreased estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) mortality are uncertain in Chinese general populations.


METHODS
Prospective cohort study.


METHODS
17,026 adults 50 years and older in Taiwan. A subset of 7,968 had repeated measurements.


METHODS
Decreased eGFR and its progression. eGFR was calculated from serum creatinine level by using the Modification of Diet in Renal Disease Study equation.


RESULTS
Mortality from all causes and CVD, including coronary heart disease (CHD) and stroke, from the National Death Registry.


METHODS
Hazard ratios (HRs) and Kaplan-Meier survival curves were calculated for participants with a moderate to severe decrease in eGFR (<60 mL/min/1.73 m(2)) compared with those with normal eGFR (> or =90 mL/min/1.73 m(2)). HR of a rapid decrease (> or =20%) in eGFR was also calculated.


RESULTS
Mean age of all participants was 57.2 +/- 5.2 (SD) years. We observed 1,682 deaths in 15 years of follow-up. Participants with a moderate to severe decrease in eGFR had increased HRs for mortality from all causes (1.44; 95% confidence interval [CI], 1.22 to 1.70), CVD (1.90; 95% CI, 1.36 to 2.65), CHD (2.07; 95% CI, 1.26 to 3.41), and stroke (2.16; 95% CI, 1.29 to 3.62) after adjusting for confounders. Decreased eGFR was associated with ischemic stroke, but not hemorrhagic stroke. No significant interaction between decreased eGFR and anemia, diabetes, or smoking was found. There were 660 participants with a 20% or greater decrease in eGFR from baseline during 18 months of follow-up. They had increased HRs for all causes (1.45; 95% CI, 1.13 to 1.86), CVD (2.48; 95% CI, 1.58 to 3.89), CHD (2.14; 95% CI, 1.07 to 4.29), and stroke (2.79; 95% CI, 1.45 to 5.36) compared with those with less than a 20% decrease in eGFR during the same period.


CONCLUSIONS
Data for proteinuria were not available. Creatinine assay was not calibrated.


CONCLUSIONS
A moderate to severe or fast decrease in eGFR was associated with all-cause and CVD mortality in this ethnic Chinese cohort.
Cheng
Ting-Yuan David
TY
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Wen
Sung-Feng
SF
Astor
Brad C
BC
Tao
Xuguang Grant
XG
Samet
Jonathan M
JM
Wen
Chi Pang
CP
D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan