title: CKD and cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study: interactions with age, sex, and race.
abstract: BACKGROUND
  Estimated glomerular filtration rate (eGFR) and albuminuria are central for diagnosis, staging, and risk evaluation in chronic kidney disease (CKD). Universal thresholds regardless of age, sex, and race are recommended, but relatively little is known about how these demographic factors alter the relationship of eGFR and albuminuria to cardiovascular outcomes.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  11,060 whites and blacks aged 52-75 years in the Atherosclerosis Risk in Communities (ARIC) Study with median follow-up of 11.2 years.
  
  
  METHODS
  eGFR by the CKD-EPI (CKD Epidemiology Collaboration) creatinine equation (reference, 95 mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (ACR; reference, 5 mg/g).
  
  
  RESULTS
  Cardiovascular events (coronary disease, stroke, and heart failure) and all-cause mortality.
  
  
  METHODS
  Adjusted HRs associated with eGFR and ACR in subgroups according to age, sex, and race.
  
  
  RESULTS
  Cardiovascular risk significantly increased at eGFR <70 mL/min/1.73 m(2) in all subgroups according to age (<65 vs ≥65 years), sex, and race (P for interaction >0.2 for these subgroups; eg, at eGFR of 30 mL/min/1.73 m(2), the adjusted HR was 2.19 [95% CI, 1.10-4.35] at age 52-64 years vs 2.23 [95% CI, 1.33-3.72] at age 65-75 years). Results were similar for mortality. Log(ACR) was associated linearly with cardiovascular risk without threshold effects in all subgroups, with some quantitative interactions. HRs according to ACR tended to be lower in men versus women (eg, at ACR of 40 mg/g, 1.18 [95% CI, 0.98-1.41] vs 1.77 [95% CI, 1.45-2.15]) and in the older versus younger population (1.24 [95% CI, 1.04-1.49] vs 1.73 [95% CI, 1.42-2.12]; P for interaction <0.01 for sex and age). Less evident interactions were observed for mortality.
  
  
  CONCLUSIONS
  Single measurement of eGFR with creatinine and ACR and relatively narrow age range.
  
  
  CONCLUSIONS
  The associations of eGFR and ACR with cardiovascular events were largely similar, with some quantitative interactions, in age, sex, and racial subgroups, generally supporting universal thresholds of GFR and ACR for CKD definition/staging.
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Xuan
authors.initials: X
authors.lastname: Hui
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.forename: Tibor
authors.initials: T
authors.lastname: Fülöp
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000652:urine; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology; D044383:Black People; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D012307:Risk Factors; D012737:Sex Factors; D044465:White People
chemical_list: D003404:Creatinine
keywords: Chronic kidney disease; all-cause mortality; cardiovascular disease; estimated glomerular filtration rate (eGFR); urinary albumin-creatinine ratio (ACR)