Kidney Function as Risk Factor and Predictor of Cardiovascular Outcomes and Mortality Among Older Adults
Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR) are associated with cardiovascular events in the general population but their utility among older adults is unclear. We investigated the associations of eGFR and UACR with stroke, myocardial infarction (MI), and...
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| Veröffentlicht in: | American journal of kidney diseases 2021-03, Vol.77 (3), p.386-396.e1 |
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| creator | Kühn, Andreas van der Giet, Markus Kuhlmann, Martin K. Martus, Peter Mielke, Nina Ebert, Natalie Schaeffner, Elke S. |
| description | Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR) are associated with cardiovascular events in the general population but their utility among older adults is unclear. We investigated the associations of eGFR and UACR with stroke, myocardial infarction (MI), and death among older adults.
Population-based cohort study.
1,581 participants (aged≥70 years) in the Berlin Initiative Study (BIS) without prior stroke or MI.
Serum creatinine- and cystatin C–based eGFR, UACR categories, and measured GFR (n=436).
Stroke, MI, and all-cause mortality.
HRs and 95% CIs derived from multivariable-adjusted Cox proportional hazards models for association analyses. Net reclassification improvement (NRI) and C statistic differences comparing the predictive benefit of kidney measures with a traditional cardiovascular risk model.
During a median follow-up of 8.2 years, 193 strokes, 125 MIs, and 531 deaths occurred. Independent of UACR, when GFR was estimated using the creatinine- and cystatin C–based BIS equation, eGFR of 45 to 59mL/min/1.73m2 (vs eGFR>60mL/min/1.73m2) was associated with stroke (HR, 2.23; 95% CI, 1.55-3.21) but not MI or all-cause mortality. For those with eGFR |
| doi_str_mv | 10.1053/j.ajkd.2020.09.015 |
| format | Article |
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Population-based cohort study.
1,581 participants (aged≥70 years) in the Berlin Initiative Study (BIS) without prior stroke or MI.
Serum creatinine- and cystatin C–based eGFR, UACR categories, and measured GFR (n=436).
Stroke, MI, and all-cause mortality.
HRs and 95% CIs derived from multivariable-adjusted Cox proportional hazards models for association analyses. Net reclassification improvement (NRI) and C statistic differences comparing the predictive benefit of kidney measures with a traditional cardiovascular risk model.
During a median follow-up of 8.2 years, 193 strokes, 125 MIs, and 531 deaths occurred. Independent of UACR, when GFR was estimated using the creatinine- and cystatin C–based BIS equation, eGFR of 45 to 59mL/min/1.73m2 (vs eGFR>60mL/min/1.73m2) was associated with stroke (HR, 2.23; 95% CI, 1.55-3.21) but not MI or all-cause mortality. For those with eGFR<45mL/min/1.73m2, the HRs were 1.99 (95% CI, 1.23-3.20) for stroke, 1.38 (95% CI, 0.81-2.36) for MI, and 1.57 (95% CI, 1.20-2.06) for mortality. Compared with UACR<30mg/g, UACR of 30 to 300mg/g was not associated with stroke (HR, 0.91; 95% CI, 0.63-1.33) but was associated with MI (HR, 1.65; 95% CI, 1.09-2.51) and all-cause mortality (HR, 1.63; 95% CI, 1.34-1.98). Prediction analysis for stroke showed significant positive NRI for eGFR calculated using the cystatin C–based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the creatinine- and cystatin C–based BIS and Full Age Spectrum equations. UACR demonstrated significant positive NRIs for MI and mortality.
eGFR and UACR categorization based on single assessments; lack of cause-specific death data.
eGFR of 45 to 59mL/min/1.73m2 without albuminuria was associated with stroke but not MI or all-cause mortality in older adults. In contrast, UACR of 30 to 300mg/g was associated with MI and all-cause mortality but not with stroke. Furthermore, cystatin C–based eGFR improved risk prediction for stroke in this cohort of older adults.
[Display omitted]</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2020.09.015</identifier><identifier>PMID: 33197533</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Albuminuria - epidemiology ; all-cause mortality ; association ; Berlin Initiative Study (BIS) ; cardiovascular disease (CVD) ; Cause of Death ; Chronic kidney disease (CKD) ; Cohort Studies ; creatinine ; Creatinine - metabolism ; cystatin C ; Cystatin C - metabolism ; elderly ; estimated glomerular filtration rate (eGFR) ; Female ; Glomerular Filtration Rate ; Humans ; Kidney - metabolism ; Kidney - physiopathology ; Kidney Function Tests ; Male ; measured GFR ; Mortality ; myocardial infarction (MI) ; Myocardial Infarction - epidemiology ; old age ; prediction ; Proportional Hazards Models ; renal function ; Renal Insufficiency, Chronic - epidemiology ; Renal Insufficiency, Chronic - metabolism ; Risk Factors ; stroke ; Stroke - epidemiology ; urinary albumin-creatinine ratio (UACR)</subject><ispartof>American journal of kidney diseases, 2021-03, Vol.77 (3), p.386-396.e1</ispartof><rights>2020 National Kidney Foundation, Inc.</rights><rights>Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-f9cef1261c4e83a040d77afef452f1b3d2b1254122316cd39683a7f33b4602633</citedby><cites>FETCH-LOGICAL-c422t-f9cef1261c4e83a040d77afef452f1b3d2b1254122316cd39683a7f33b4602633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0272638620310933$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33197533$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kühn, Andreas</creatorcontrib><creatorcontrib>van der Giet, Markus</creatorcontrib><creatorcontrib>Kuhlmann, Martin K.</creatorcontrib><creatorcontrib>Martus, Peter</creatorcontrib><creatorcontrib>Mielke, Nina</creatorcontrib><creatorcontrib>Ebert, Natalie</creatorcontrib><creatorcontrib>Schaeffner, Elke S.</creatorcontrib><title>Kidney Function as Risk Factor and Predictor of Cardiovascular Outcomes and Mortality Among Older Adults</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR) are associated with cardiovascular events in the general population but their utility among older adults is unclear. We investigated the associations of eGFR and UACR with stroke, myocardial infarction (MI), and death among older adults.
Population-based cohort study.
1,581 participants (aged≥70 years) in the Berlin Initiative Study (BIS) without prior stroke or MI.
Serum creatinine- and cystatin C–based eGFR, UACR categories, and measured GFR (n=436).
Stroke, MI, and all-cause mortality.
HRs and 95% CIs derived from multivariable-adjusted Cox proportional hazards models for association analyses. Net reclassification improvement (NRI) and C statistic differences comparing the predictive benefit of kidney measures with a traditional cardiovascular risk model.
During a median follow-up of 8.2 years, 193 strokes, 125 MIs, and 531 deaths occurred. Independent of UACR, when GFR was estimated using the creatinine- and cystatin C–based BIS equation, eGFR of 45 to 59mL/min/1.73m2 (vs eGFR>60mL/min/1.73m2) was associated with stroke (HR, 2.23; 95% CI, 1.55-3.21) but not MI or all-cause mortality. For those with eGFR<45mL/min/1.73m2, the HRs were 1.99 (95% CI, 1.23-3.20) for stroke, 1.38 (95% CI, 0.81-2.36) for MI, and 1.57 (95% CI, 1.20-2.06) for mortality. Compared with UACR<30mg/g, UACR of 30 to 300mg/g was not associated with stroke (HR, 0.91; 95% CI, 0.63-1.33) but was associated with MI (HR, 1.65; 95% CI, 1.09-2.51) and all-cause mortality (HR, 1.63; 95% CI, 1.34-1.98). Prediction analysis for stroke showed significant positive NRI for eGFR calculated using the cystatin C–based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the creatinine- and cystatin C–based BIS and Full Age Spectrum equations. UACR demonstrated significant positive NRIs for MI and mortality.
eGFR and UACR categorization based on single assessments; lack of cause-specific death data.
eGFR of 45 to 59mL/min/1.73m2 without albuminuria was associated with stroke but not MI or all-cause mortality in older adults. In contrast, UACR of 30 to 300mg/g was associated with MI and all-cause mortality but not with stroke. Furthermore, cystatin C–based eGFR improved risk prediction for stroke in this cohort of older adults.
[Display omitted]</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Albuminuria - epidemiology</subject><subject>all-cause mortality</subject><subject>association</subject><subject>Berlin Initiative Study (BIS)</subject><subject>cardiovascular disease (CVD)</subject><subject>Cause of Death</subject><subject>Chronic kidney disease (CKD)</subject><subject>Cohort Studies</subject><subject>creatinine</subject><subject>Creatinine - metabolism</subject><subject>cystatin C</subject><subject>Cystatin C - metabolism</subject><subject>elderly</subject><subject>estimated glomerular filtration rate (eGFR)</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Kidney - metabolism</subject><subject>Kidney - physiopathology</subject><subject>Kidney Function Tests</subject><subject>Male</subject><subject>measured GFR</subject><subject>Mortality</subject><subject>myocardial infarction (MI)</subject><subject>Myocardial Infarction - epidemiology</subject><subject>old age</subject><subject>prediction</subject><subject>Proportional Hazards Models</subject><subject>renal function</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Renal Insufficiency, Chronic - metabolism</subject><subject>Risk Factors</subject><subject>stroke</subject><subject>Stroke - epidemiology</subject><subject>urinary albumin-creatinine ratio (UACR)</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFu1DAURS0EotPCD7BAXrJJsP0cJ5HYjEYdqCgahGBteexn8DSJi-1Umr8n0yksWT096dwr3UPIG85qzhp4f6jN4c7VgglWs75mvHlGVrwRUKkOuudkxUQrKgWduiCXOR8YYz0o9ZJcAPC-bQBW5Nfn4CY80u082RLiRE2m30K-o1tjS0zUTI5-TejC4xc93ZjkQnww2c6DSXQ3FxtHzI_gl5iKGUI50vUYp590NzhMdO3moeRX5IU3Q8bXT_eK_Nhef998qm53H28269vKSiFK5XuLngvFrcQODJPMta3x6GUjPN-DE3suGsmFAK6sg36ZaloPsJeKCQVwRd6de-9T_D1jLnoM2eIwmAnjnLWQikPXS8kXVJxRm2LOCb2-T2E06ag50yfD-qBPhvXJsGa9XgwvobdP_fN-RPcv8lfpAnw4A7isfAiYdLYBJ7s4TGiLdjH8r_8PGHmMOQ</recordid><startdate>202103</startdate><enddate>202103</enddate><creator>Kühn, Andreas</creator><creator>van der Giet, Markus</creator><creator>Kuhlmann, Martin K.</creator><creator>Martus, Peter</creator><creator>Mielke, Nina</creator><creator>Ebert, Natalie</creator><creator>Schaeffner, Elke S.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202103</creationdate><title>Kidney Function as Risk Factor and Predictor of Cardiovascular Outcomes and Mortality Among Older Adults</title><author>Kühn, Andreas ; van der Giet, Markus ; Kuhlmann, Martin K. ; Martus, Peter ; Mielke, Nina ; Ebert, Natalie ; Schaeffner, Elke S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-f9cef1261c4e83a040d77afef452f1b3d2b1254122316cd39683a7f33b4602633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Albuminuria - epidemiology</topic><topic>all-cause mortality</topic><topic>association</topic><topic>Berlin Initiative Study (BIS)</topic><topic>cardiovascular disease (CVD)</topic><topic>Cause of Death</topic><topic>Chronic kidney disease (CKD)</topic><topic>Cohort Studies</topic><topic>creatinine</topic><topic>Creatinine - metabolism</topic><topic>cystatin C</topic><topic>Cystatin C - metabolism</topic><topic>elderly</topic><topic>estimated glomerular filtration rate (eGFR)</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Kidney - metabolism</topic><topic>Kidney - physiopathology</topic><topic>Kidney Function Tests</topic><topic>Male</topic><topic>measured GFR</topic><topic>Mortality</topic><topic>myocardial infarction (MI)</topic><topic>Myocardial Infarction - epidemiology</topic><topic>old age</topic><topic>prediction</topic><topic>Proportional Hazards Models</topic><topic>renal function</topic><topic>Renal Insufficiency, Chronic - epidemiology</topic><topic>Renal Insufficiency, Chronic - metabolism</topic><topic>Risk Factors</topic><topic>stroke</topic><topic>Stroke - epidemiology</topic><topic>urinary albumin-creatinine ratio (UACR)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kühn, Andreas</creatorcontrib><creatorcontrib>van der Giet, Markus</creatorcontrib><creatorcontrib>Kuhlmann, Martin K.</creatorcontrib><creatorcontrib>Martus, Peter</creatorcontrib><creatorcontrib>Mielke, Nina</creatorcontrib><creatorcontrib>Ebert, Natalie</creatorcontrib><creatorcontrib>Schaeffner, Elke S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kühn, Andreas</au><au>van der Giet, Markus</au><au>Kuhlmann, Martin K.</au><au>Martus, Peter</au><au>Mielke, Nina</au><au>Ebert, Natalie</au><au>Schaeffner, Elke S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Kidney Function as Risk Factor and Predictor of Cardiovascular Outcomes and Mortality Among Older Adults</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2021-03</date><risdate>2021</risdate><volume>77</volume><issue>3</issue><spage>386</spage><epage>396.e1</epage><pages>386-396.e1</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR) are associated with cardiovascular events in the general population but their utility among older adults is unclear. We investigated the associations of eGFR and UACR with stroke, myocardial infarction (MI), and death among older adults.
Population-based cohort study.
1,581 participants (aged≥70 years) in the Berlin Initiative Study (BIS) without prior stroke or MI.
Serum creatinine- and cystatin C–based eGFR, UACR categories, and measured GFR (n=436).
Stroke, MI, and all-cause mortality.
HRs and 95% CIs derived from multivariable-adjusted Cox proportional hazards models for association analyses. Net reclassification improvement (NRI) and C statistic differences comparing the predictive benefit of kidney measures with a traditional cardiovascular risk model.
During a median follow-up of 8.2 years, 193 strokes, 125 MIs, and 531 deaths occurred. Independent of UACR, when GFR was estimated using the creatinine- and cystatin C–based BIS equation, eGFR of 45 to 59mL/min/1.73m2 (vs eGFR>60mL/min/1.73m2) was associated with stroke (HR, 2.23; 95% CI, 1.55-3.21) but not MI or all-cause mortality. For those with eGFR<45mL/min/1.73m2, the HRs were 1.99 (95% CI, 1.23-3.20) for stroke, 1.38 (95% CI, 0.81-2.36) for MI, and 1.57 (95% CI, 1.20-2.06) for mortality. Compared with UACR<30mg/g, UACR of 30 to 300mg/g was not associated with stroke (HR, 0.91; 95% CI, 0.63-1.33) but was associated with MI (HR, 1.65; 95% CI, 1.09-2.51) and all-cause mortality (HR, 1.63; 95% CI, 1.34-1.98). Prediction analysis for stroke showed significant positive NRI for eGFR calculated using the cystatin C–based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the creatinine- and cystatin C–based BIS and Full Age Spectrum equations. UACR demonstrated significant positive NRIs for MI and mortality.
eGFR and UACR categorization based on single assessments; lack of cause-specific death data.
eGFR of 45 to 59mL/min/1.73m2 without albuminuria was associated with stroke but not MI or all-cause mortality in older adults. In contrast, UACR of 30 to 300mg/g was associated with MI and all-cause mortality but not with stroke. Furthermore, cystatin C–based eGFR improved risk prediction for stroke in this cohort of older adults.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33197533</pmid><doi>10.1053/j.ajkd.2020.09.015</doi></addata></record> |
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| subjects | Aged Aged, 80 and over Albuminuria - epidemiology all-cause mortality association Berlin Initiative Study (BIS) cardiovascular disease (CVD) Cause of Death Chronic kidney disease (CKD) Cohort Studies creatinine Creatinine - metabolism cystatin C Cystatin C - metabolism elderly estimated glomerular filtration rate (eGFR) Female Glomerular Filtration Rate Humans Kidney - metabolism Kidney - physiopathology Kidney Function Tests Male measured GFR Mortality myocardial infarction (MI) Myocardial Infarction - epidemiology old age prediction Proportional Hazards Models renal function Renal Insufficiency, Chronic - epidemiology Renal Insufficiency, Chronic - metabolism Risk Factors stroke Stroke - epidemiology urinary albumin-creatinine ratio (UACR) |
| title | Kidney Function as Risk Factor and Predictor of Cardiovascular Outcomes and Mortality Among Older Adults |
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