The association of renal impairment with all-cause and cardiovascular disease mortality.

Journal article

Background. The prognostic value of reduced glomerular filtration rate (GFR) was examined in a community-based cohort of British women. Methods. Serum creatinine measurements were available for 90% (n = 3851) of a representative random sample of 4286 women aged 60-79 years. GFR was estimated using the Modification of Diet in Renal Disease equation. Hazard ratios (HR) were calculated using Cox regression with outcomes of all-cause and cardiovascular disease (CVD) mortality. Results. Eight hundred and thirty-two women (21.6%) had a GFR <60 ml/min/1.73 m(2). Over a median follow-up of 5.6 years, there were 318 deaths (100 CVD deaths). Women with GFR <60 ml/min/1.73 m(2) compared to all others showed only a borderline increased risk of all-cause mortality [HR 1.35 (95% confidence intervals: 0.99, 1.85)] and CVD mortality [1.34 (0.97, 1.85)]. Adjustment for conventional CVD risk factors had little impact. The association with CVD mortality was attenuated in women with pre-existing CVD [adjusted HR: 0.51 (0.24, 1.04)]. Only the subset of women without CVD at baseline were at risk for later CVD death [adjusted HR: 1.80 (1.13, 2.88)]. Conclusions. A substantial proportion of older British women have GFR <60 ml/min/1.73 m(2) without strong evidence for statistical association with all-cause mortality. The effect on CVD mortality is partly explained by existing CVD and its risk factors. GFR measurement appears only to play a useful role in the subset of older women without pre-existing CVD who are at higher risk of premature CVD death.

Authors: Nitsch, D; Lawlor, D; Patel, R; Carson, C; Ebrahim, S

• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
• Volume: 25
• Issue: 4
• Pages: 1191-1199
• Publication date: 2010-04-01
• DOI: 10.1093/ndt/gfp607
• EISSN: 1460-2385
• ISSN: 0931-0509
• Language: English
• Keywords: Female; Humans; Cardiovascular Diseases; Glomerular Filtration Rate; Cohort Studies; Risk Factors; Prognosis; Middle Aged; Male; Kidney Failure, Chronic; Cause of Death; Aged; Kidney Function Tests; Creatinine; Diet