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Kidney Function and Mortality in Octogenarians: Cardiovascular Health Study All Stars
Author(s) -
Shastri Shani,
Katz Ronit,
Rifkin Dena E.,
Fried Linda F.,
Odden Michelle C.,
Peralta Carmen A.,
Chonchol Michel,
Siscovick David,
Shlipak Michael G.,
Newman Anne B.,
Sarnak Mark J.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04046.x
Subject(s) - medicine , renal function , hazard ratio , cystatin c , kidney disease , creatinine , confidence interval , proportional hazards model , diabetes mellitus , urology , epidemiology , endocrinology
Objectives To examine the association between kidney function and all‐cause mortality in octogenarians. Design Retrospective analysis of prospectively collected data. Setting Community. Participants Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study ( CHS ) All Stars participants. Measurements Estimated glomerular filtration rate (e GFR ) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (e GFR CR ) and cystatin C one‐variable (e GFR CYS ) equations. The association between quintiles of kidney function and all‐cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. Results Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow‐up of 2.6 years. The association between e GFR CR and all‐cause mortality was U‐shaped. In comparison with the reference quintile (64–75 mL/min per 1.73 m 2 ), the highest (≥75 mL/min per 1.73 m 2 ) and lowest (≤43 mL/min per 1.73 m 2 ) quintiles of e GFR CR were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36–4.55; HR = 2.28, 95% CI = 1.26–4.10, respectively). The association between e GFR CYS and all‐cause mortality was linear in those with e GFR CYS of less than 60 mL/min per 1.73 m 2 , and in the multivariate analyses, the lowest quintile of e GFR CYS (<52 mL/min per 1.73 m 2 ) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12–3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m 2 ). Conclusion Moderate reduction in kidney function is a risk factor for all‐cause mortality in octogenarians. The association between e GFR CR and all‐cause mortality differed from that observed with e GFR CYS ; the relationship was U‐shaped for e GFR CR , whereas the risk was primarily present in the lowest quintile for e GFR CYS .