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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Rapid kidney function decline and mortality risk in older adults
Dena E Rifkin1, Michael G Shlipak, Ronit Katz
1Division of Nephrology, Tufts Medical Center, 750 Washington St, Box 391, Boston, MA 02111, USA. drifkin@tuftsmedicalcenter.org
Archives of Internal Medicine
|November 13, 2008
Summary
Rapid decline in kidney function, measured by estimated glomerular filtration rate (eGFR), significantly increases mortality risk in older adults. This association holds true regardless of initial kidney function or other demographic factors.
Area of Science:
- Nephrology
- Geriatrics
- Epidemiology
Background:
- Impaired kidney function is a known risk factor for mortality in older adults.
- The independent association between longitudinal declines in kidney function and mortality risk requires further investigation.
Purpose of the Study:
- To determine if longitudinal declines in estimated glomerular filtration rate (eGFR) are independently associated with cardiovascular and all-cause mortality in older adults.
Main Methods:
- The Cardiovascular Health Study followed 4380 community-dwelling older adults from 1989-2005.
- Annual decline in eGFR was estimated using both serum creatinine (eGFR(creat)) and cystatin C (eGFR(cys)).
- Rapid eGFR decline was defined as >3 mL/min/1.73 m(2)/year; mortality was assessed over a mean of 9.9 years.
Main Results:
- A rapid decline in eGFR (by either eGFR(creat) or eGFR(cys)) was associated with significantly increased cardiovascular and all-cause mortality.
- Individuals with rapid eGFR(creat) decline (16%) had an adjusted hazard ratio of 1.70 for cardiovascular and 1.73 for all-cause mortality.
- Individuals with rapid eGFR(cys) decline (25%) had an adjusted hazard ratio of 1.53 for both cardiovascular and all-cause mortality.
Conclusions:
- Rapid decline in eGFR independently predicts increased cardiovascular and all-cause mortality in older adults.
- This association was consistent across various subgroups, including baseline kidney function, age, sex, race, and prevalent coronary heart disease.
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