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. 2016 Oct:180:46-53.
doi: 10.1016/j.ahj.2016.07.004. Epub 2016 Jul 14.

Kidney function and sudden cardiac death in the community: The Atherosclerosis Risk in Communities (ARIC) Study

Takeki Suzuki  1 , Sunil K Agarwal  2 , Rajat Deo  3 , Nona Sotoodehnia  4 , Morgan E Grams  2 , Elizabeth Selvin  5 , Hugh Calkins  2 , Wayne Rosamond  6 , Gordon Tomaselli  2 , Josef Coresh  5 , Kunihiro Matsushita  7
Affiliations

Kidney function and sudden cardiac death in the community: The Atherosclerosis Risk in Communities (ARIC) Study

Takeki Suzuki et al. Am Heart J. 2016 Oct.

Abstract

Background: Individuals with chronic kidney disease, particularly those requiring dialysis, are at high risk of sudden cardiac death (SCD). However, comprehensive data for the full spectrum of kidney function and SCD risk in the community are sparse. Furthermore, newly developed equations for estimated glomerular filtration rate (eGFR) and novel filtration markers might add further insight to the role of kidney function in SCD.

Methods: We investigated the associations of baseline eGFRs using serum creatinine, cystatin C, or both (eGFRcr, eGFRcys, and eGFRcr-cys); cystatin C itself; and β2-microglobulin (B2M) with SCD (205 cases through 2001) among 13,070 black and white ARIC participants at baseline during 1990-1992 using Cox regression models accounting for potential confounders.

Results: Low eGFR was independently associated with SCD risk: for example, hazard ratio for eGFR <45 versus ≥90mL/(min 1.73m(2)) was 3.71 (95% CI 1.74-7.90) with eGFRcr, 5.40 (2.97-9.83) with eGFRcr-cys, and 5.24 (3.01-9.11) with eGFRcys. When eGFRcr and eGFRcys were included together in a single model, the association was only significant for eGFRcys. When three eGFRs, cystatin C, and B2M were divided into quartiles, B2M demonstrated the strongest association with SCD (hazard ratio for fourth quartile vs first quartile 3.48 (2.03-5.96) vs ≤2.7 for the other kidney markers).

Conclusions: Kidney function was independently and robustly associated with SCD in the community, particularly when cystatin C or B2M was used. These results suggest the potential value of kidney function as a risk factor for SCD and the advantage of novel filtration markers over eGFRcr in this context.

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Figures

Figure 1
Figure 1
Age-, Sex-, and Race-adjusted Incidence Rate of SCD based on eGFR
Figure 2
Figure 2
Subgroup Comparisons by Kidney Filtration Markers (above vs. below median) across Demographic and Clinical Subgroups.* Every P value for interaction was ≥0.05 *adjusted for age, sex, race, field center, education, CHD, HF, DM, hypertension, heart rate, Cornell voltage, BMI, HDL and LDL cholesterols, current drinking, and current smoking
See this image and copyright information in PMC

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