Kidney function and mortality in octogenarians: Cardiovascular Health Study All Stars.
OBJECTIVE
To examine the association between kidney function and all-cause mortality in octogenarians.


METHODS
Retrospective analysis of prospectively collected data.


METHODS
Community.


METHODS
Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study (CHS) All Stars participants.


METHODS
Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (eGFR(CR) ) and cystatin C one-variable (eGFR(CYS) ) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models.


RESULTS
Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between eGFR(CR) and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m(2) ), the highest (≥ 75 mL/min per 1.73 m(2) ) and lowest (≤ 43 mL/min per 1.73 m(2) ) quintiles of eGFR(CR) were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between eGFR(CYS) and all-cause mortality was linear in those with eGFR(CYS) of less than 60 mL/min per 1.73 m(2) , and in the multivariate analyses, the lowest quintile of eGFR(CYS) (<52 mL/min per 1.73 m(2) ) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m(2) ).


CONCLUSIONS
Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFR(CR) and all-cause mortality differed from that observed with eGFR(CYS) ; the relationship was U-shaped for eGFR(CR) , whereas the risk was primarily present in the lowest quintile for eGFR(CYS) .
Division of Nephrology, University of Texas Southwestern, Dallas, Texas 75390, USA. Shani.Shastri@UTSouthwestern.edu
Shani
S
Shastri
Ronit
R
Katz
Dena E
DE
Rifkin
Linda F
LF
Fried
Michelle C
MC
Odden
Carmen A
CA
Peralta
Michel
M
Chonchol
David
D
Siscovick
Michael G
MG
Shlipak
Anne B
AB
Newman
Mark J
MJ
Sarnak
D000369:Aged, 80 and over; D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000401:mortality*; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007674:Kidney Diseases / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D055316:Cystatin C; D003404:Creatinine