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. 2008 Nov 10;168(20):2212-8.
doi: 10.1001/archinte.168.20.2212.

Rapid kidney function decline and mortality risk in older adults

Dena E Rifkin  1 , Michael G Shlipak, Ronit Katz, Linda F Fried, David Siscovick, Michel Chonchol, Anne B Newman, Mark J Sarnak
Affiliations

Rapid kidney function decline and mortality risk in older adults

Dena E Rifkin et al. Arch Intern Med. .

Abstract

Background: Impaired kidney function is associated with increased mortality risk in older adults. It remains unknown, however, whether longitudinal declines in kidney function are independently associated with increased cardiovascular and all-cause mortality in older adults.

Methods: The Cardiovascular Health Study evaluated a cohort of community-dwelling older adults enrolled from 1989 to 1993 in 4 US communities with follow-up through 2005. Among 4380 participants, the slope of annual decline in estimated glomerular filtration rate (eGFR) was estimated using both serum creatinine (eGFR(creat)) and cystatin C (eGFR(cys)) rates, which were measured at baseline, year 3, and year 7 of follow-up. Rapid decline in eGFR was defined as a loss greater than 3 mL/min/1.73 m(2) per year, and cardiovascular and all-cause mortality were assessed over a mean of 9.9 years of follow-up.

Results: Mean (SD) levels of creatinine and cystatin C were 0.93 (0.30) mg/dL and 1.03 (0.25) mg/L, respectively; mean (SD) eGFR(creat) and eGFR(cys) were 79 (23) mL/min/1.73 m(2) and 79 (19) mL/min/1.73 m(2), respectively. Individuals with rapid decline measured by eGFR(creat) (n = 714; 16%) had increased risk of cardiovascular (adjusted hazard ratio [AHR], 1.70; 95% confidence interval [CI], 1.40-2.06) and all-cause (AHR, 1.73; 95% CI, 1.54-1.94) mortality. Individuals with rapid decline measured by eGFR(cys) (n = 1083; 25%) also had increased risk of cardiovascular (AHR, 1.53; 95% CI, 1.29-1.80) and all-cause (AHR, 1.53; 95% CI, 1.38-1.69) mortality. The association of rapid decline in eGFR with elevated mortality risk did not differ across subgroups based on baseline kidney function, age, sex, race, or prevalent coronary heart disease.

Conclusion: Rapid decline in eGFR is associated with an increased risk of cardiovascular and all-cause mortality in older adults, independent of baseline eGFR and other demographic variables.

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Figures

Figure 1
Figure 1
Association of kidney function decline by cystatin C–based estimated glomerular filtration rate (eGFRcys) with all-cause mortality (spline analysis, with top and bottom 2.5% removed).
Figure 2
Figure 2
Association of rapid kidney decline with all-cause (A) and cardiovascular (B) mortality risk within subgroups. Error bars represent 95% confidence intervals. CHD indicates coronary heart disease; CKD, chronic kidney disease; eGFRcreat, estimated glomerular filtration rate (eGFR) by creatinine measurement; eGFRcys, eGFR by cystatin C measurement; high risk, presence of 1 or more of the following: diabetes mellitus, hypertension, or cardiovascular disease at baseline; low risk, absence of all of the following: diabetes mellitus, hypertension, and cardiovascular disease at baseline.
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