Rapid decline of kidney function increases cardiovascular risk in the elderly.
Chronic kidney disease (CKD), defined at a specific time point, is an important risk factor for cardiovascular disease. Whether the rate of kidney function decline contributes additional cardiovascular risk is unknown. In the Cardiovascular Health Study, we compared the associations of changes in kidney function during the first 7 yr with the incidence of heart failure (HF), myocardial infarction (MI), stroke, and peripheral arterial disease (PAD) during the subsequent 8 yr. We defined a rapid decline in cystatin C-based estimated GFR as >3 ml/min per 1.73 m(2)/yr, on the basis of determination at baseline, year 3, and year 7. Among eligible participants, 1083 (24%) had rapid kidney decline. The incidence of each type of cardiovascular event was significantly higher among patients with rapid decline (all P < 0.001). After multivariate adjustment for demographics, cardiovascular disease risk factors, and baseline kidney function, rapid kidney function decline was significantly associated with HF (adjusted hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.13 to 1.53), MI (HR 1.48; 95% CI 1.21 to 1.83), and PAD (HR 1.67; 95% CI 1.02 to 2.75) but not with stroke (HR 1.19; 95% CI 0.97 to 1.45). The association of rapid decline with each outcome did not differ by the presence or absence of CKD. In conclusion, declining kidney function associates with higher risk for HF, MI, and PAD among patients with or without CKD.
Shlipak
Michael G
MG
General Internal Medicine Section, San Francisco VA Medical Center and Departments of Medicine, Epidemiology,and Biostatistics, University of California-San Francisco, 4150 Clement Street, San Francisco, CA 94121, USA. michael.shlipak@ucsf.edu
Katz
Ronit
R
Kestenbaum
Bryan
B
Siscovick
David
D
Fried
Linda
L
Newman
Anne
A
Rifkin
Dena
D
Sarnak
Mark J
MJ
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D055316:Cystatin C; D003404:Creatinine