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Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients: A 10-year follow-up
Ellen K Hoogeveen1,2,3, Johanna M Geleijnse4, Erik J Giltay5
1Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
Insights
Chronic kidney disease (CKD) independently increases mortality risk in older patients after myocardial infarction (MI), even with optimal drug treatment. Lower kidney function, particularly below 80 ml/min/1.73 m2, linearly elevates risks for cardiovascular and non-cardiovascular deaths.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Chronic kidney disease (CKD) is common in older patients post-myocardial infarction (MI).
- The independent impact of CKD on mortality in optimally treated post-MI patients remains unclear.
Purpose of the Study:
- To investigate the association between kidney function and all-cause and cause-specific mortality in older post-MI patients receiving optimal cardiovascular pharmacotherapy.
Main Methods:
- 4,561 Dutch post-MI patients (2002-2012) were analyzed.
- Estimated Glomerular Filtration Rate (eGFR) was calculated using cystatin C (cysC) and creatinine (cr).
- Cox models and restricted cubic splines assessed mortality risks across eGFR categories.
Main Results:
- Mortality risk increased linearly as eGFRcysC declined below 80 ml/min/1.73 m2.
- Hazard ratios for all-cause mortality significantly rose with decreasing eGFRcysC.
- CKD was associated with increased risks of cardiovascular, cancer, and other causes of death.
Conclusions:
- Reduced kidney function is an independent predictor of mortality in optimally treated older post-MI patients.
- A linear increase in mortality risk was observed below an eGFR of 80 ml/min/1.73 m2.
- These findings highlight the importance of kidney function assessment in post-MI patient management.
Abstract:
Chronic kidney disease (CKD) is highly prevalent among older post-myocardial infarction (MI) patients. It is not known whether CKD is an independent risk factor for mortality in older post-MI patients with optimal cardiovascular drug-treatment. Therefore, we studied the relation between kidney function and all-cause and specific mortality among older post-MI patients, without severe heart failure, who are treated with state-of-the-art pharmacotherapy. From 2002-2006, 4,561 Dutch post-MI patients were enrolled and followed until death or January 2012. We estimated Glomerular Filtration Rate (eGFR) with cystatin C (cysC) and creatinine (cr) using the CKD-EPI equations and analyzed the relation with any and major causes of death using Cox models and restricted cubic splines. Mean (SD) for age was 69 years (5.6), 79% were men, 17% smoked, 21% had diabetes, 90% used antihypertensive drugs, 98% used antithrombotic drugs and 85% used statins. Patients were divided into four categories of baseline eGFRcysC: ≥90 (33%; reference), 60-89 (47%), 30-59 (18%), and <30 (2%) ml/min/1.73m2. Median follow-up was 6.4 years. During follow-up, 873 (19%) patients died: 370 (42%) from cardiovascular causes, 309 (35%) from cancer, and 194 (22%) from other causes. After adjustment for age, sex and classic cardiovascular risk factor, hazard ratios (95%-confidence intervals) for any death according to the four eGFRcysC categories were: 1 (reference), 1.4 (1.1-1.7), 2.9 (2.3-3.6) and 4.4 (3.0-6.4). The hazard ratios of all-cause and cause-specific mortality increased linearly below kidney functions of 80 ml/min/1.73 m2. Weaker results were obtained for eGFRcr. To conclude, we found in optimal cardiovascular drug-treated post-MI patients an inverse graded relation between kidney function and mortality for both cardiovascular as well as non-cardiovascular causes. Risk of mortality increased linearly below kidney function of about 80 ml/min/1.73 m2.
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