title: Albuminuria, impaired kidney function and cardiovascular outcomes or mortality in the elderly.
abstract: BACKGROUND
  Kidney disease is a risk factor for mortality and cardiovascular disease in older adults, but the separate and combined effects of albuminuria and cystatin C, a novel marker of glomerular filtration, are not known.
  
  
  METHODS
  We examined associations of these markers with mortality and cardiovascular outcomes during a median follow-up of 8.3 years in 3291 older adults in the Cardiovascular Health Study. Kidney disease was assessed using urinary albumin/creatinine ratio (ACR), cystatin C and Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR). We defined subgroups based on presence of microalbuminuria (MA, ACR > 30 mg/g) and categories of normal kidney function (cystatin C < 1.0 mg/L and eGFR > 60 mL/min/1.73 m(2)); preclinical kidney disease (cystatin C level > 1.0 mg/l but eGFR > 60 mL/min/1.73 m(2)); and chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73 m(2)). Cox proportional hazards models were used to examine associations between these six subgroups and all-cause or cardiovascular mortality, myocardial infarction and heart failure.
  
  
  RESULTS
  One thousand one hundred fifty (34.9%) had normal kidney function (12.2% with MA), 1518 (46.1%) had preclinical kidney disease (17.9% with MA) and 622 (18.9%) had CKD (47% with MA). After adjustment, the presence of either preclinical kidney disease or MA was associated with an over 50% increase in mortality risk; the presence of both was associated with a 2.4-fold mortality risk. Those with CKD and MA were at highest risk, with a nearly 4-fold mortality risk.
  
  
  CONCLUSIONS
  Elevated cystatin C and albuminuria are common, identify different subsets of the older population, and are independent, graded risk factors for cardiovascular disease and mortality.
authors.affiliation: Tufts Medical Center and Tufts University School of Medicine, University of Washington, Seattle, USA. drifkin@ucsd.edu
authors.forename: Dena E
authors.initials: DE
authors.lastname: Rifkin
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: Jie
authors.initials: J
authors.lastname: Cao
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D003404:Creatinine / Q000652:urine; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D012307:Risk Factors
chemical_list: C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine