BACKGROUND: Kidney disease is a risk factor for mortality and cardiovascular disease in older adults, but the separate and combined effects of albuminuria and cystatin C, a novel marker of glomerular filtration, are not known. METHODS: We examined associations of these markers with mortality and cardiovascular outcomes during a median follow-up of 8.3 years in 3291 older adults in the Cardiovascular Health Study. Kidney disease was assessed using urinary albumin/creatinine ratio (ACR), cystatin C and Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR). We defined subgroups based on presence of microalbuminuria (MA, ACR > 30 mg/g) and categories of normal kidney function (cystatin C < 1.0 mg/L and eGFR > 60 mL/min/1.73 m(2)); preclinical kidney disease (cystatin C level > 1.0 mg/l but eGFR > 60 mL/min/1.73 m(2)); and chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73 m(2)). Cox proportional hazards models were used to examine associations between these six subgroups and all-cause or cardiovascular mortality, myocardial infarction and heart failure. RESULTS: One thousand one hundred fifty (34.9%) had normal kidney function (12.2% with MA), 1518 (46.1%) had preclinical kidney disease (17.9% with MA) and 622 (18.9%) had CKD (47% with MA). After adjustment, the presence of either preclinical kidney disease or MA was associated with an over 50% increase in mortality risk; the presence of both was associated with a 2.4-fold mortality risk. Those with CKD and MA were at highest risk, with a nearly 4-fold mortality risk. CONCLUSION: Elevated cystatin C and albuminuria are common, identify different subsets of the older population, and are independent, graded risk factors for cardiovascular disease and mortality.
BACKGROUND:Kidney disease is a risk factor for mortality and cardiovascular disease in older adults, but the separate and combined effects of albuminuria and cystatin C, a novel marker of glomerular filtration, are not known. METHODS: We examined associations of these markers with mortality and cardiovascular outcomes during a median follow-up of 8.3 years in 3291 older adults in the Cardiovascular Health Study. Kidney disease was assessed using urinary albumin/creatinine ratio (ACR), cystatin C and Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR). We defined subgroups based on presence of microalbuminuria (MA, ACR > 30 mg/g) and categories of normal kidney function (cystatin C < 1.0 mg/L and eGFR > 60 mL/min/1.73 m(2)); preclinical kidney disease (cystatin C level > 1.0 mg/l but eGFR > 60 mL/min/1.73 m(2)); and chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73 m(2)). Cox proportional hazards models were used to examine associations between these six subgroups and all-cause or cardiovascular mortality, myocardial infarction and heart failure. RESULTS: One thousand one hundred fifty (34.9%) had normal kidney function (12.2% with MA), 1518 (46.1%) had preclinical kidney disease (17.9% with MA) and 622 (18.9%) had CKD (47% with MA). After adjustment, the presence of either preclinical kidney disease or MA was associated with an over 50% increase in mortality risk; the presence of both was associated with a 2.4-fold mortality risk. Those with CKD and MA were at highest risk, with a nearly 4-fold mortality risk. CONCLUSION: Elevated cystatin C and albuminuria are common, identify different subsets of the older population, and are independent, graded risk factors for cardiovascular disease and mortality.
Authors: Guruprasad Manjunath; Hocine Tighiouart; Josef Coresh; Bonnie Macleod; Deeb N Salem; John L Griffith; Andrew S Levey; Mark J Sarnak Journal: Kidney Int Date: 2003-03 Impact factor: 10.612
Authors: Hans L Hillege; Vaclav Fidler; Gilles F H Diercks; Wiek H van Gilst; Dick de Zeeuw; Dirk J van Veldhuisen; Rijk O B Gans; Wilbert M T Janssen; Diederick E Grobbee; Paul E de Jong Journal: Circulation Date: 2002-10-01 Impact factor: 29.690
Authors: Linda F Fried; Michael G Shlipak; Casey Crump; Anthony J Bleyer; John S Gottdiener; Richard A Kronmal; Lewis H Kuller; Anne B Newman Journal: J Am Coll Cardiol Date: 2003-04-16 Impact factor: 24.094
Authors: Mark J Sarnak; Andrew S Levey; Anton C Schoolwerth; Josef Coresh; Bruce Culleton; L Lee Hamm; Peter A McCullough; Bertram L Kasiske; Ellie Kelepouris; Michael J Klag; Patrick Parfrey; Marc Pfeffer; Leopoldo Raij; David J Spinosa; Peter W Wilson Journal: Hypertension Date: 2003-11 Impact factor: 10.190
Authors: Erik M Stuveling; Hans L Hillege; Stephan J L Bakker; Reinold O B Gans; Paul E De Jong; Dick De Zeeuw Journal: Kidney Int Date: 2003-02 Impact factor: 10.612
Authors: Howard A Fink; Tien N Vo; Lisa Langsetmo; Joshua I Barzilay; Jane A Cauley; John T Schousboe; Eric S Orwoll; Muna T Canales; Areef Ishani; Nancy E Lane; Kristine E Ensrud Journal: J Bone Miner Res Date: 2017-02-21 Impact factor: 6.741
Authors: S Jeson Sangaralingham; Denise M Heublein; Joseph P Grande; Alessandro Cataliotti; Andrew D Rule; Paul M McKie; Fernando L Martin; John C Burnett Journal: Am J Physiol Renal Physiol Date: 2011-08-24
Authors: Joachim H Ix; Ronit Katz; Bryan R Kestenbaum; Ian H de Boer; Michel Chonchol; Kenneth J Mukamal; Dena Rifkin; David S Siscovick; Mark J Sarnak; Michael G Shlipak Journal: J Am Coll Cardiol Date: 2012-06-13 Impact factor: 24.094
Authors: Dinna N Cruz; Ching Yan Goh; Alberto Palazzuoli; Leo Slavin; Anna Calabrò; Claudio Ronco; Alan Maisel Journal: Heart Fail Rev Date: 2011-11 Impact factor: 4.214
Authors: Isha Agarwal; Nicole L Glazer; Eddy Barasch; Mary L Biggs; Luc Djousse; Annette L Fitzpatrick; John S Gottdiener; Joachim H Ix; Jorge R Kizer; Eric B Rimm; David S Sicovick; Russell P Tracy; Kenneth J Mukamal Journal: Circ Arrhythm Electrophysiol Date: 2014-06-24
Authors: Mark J Sarnak; Ronit Katz; Anne Newman; Tamara Harris; Carmen A Peralta; Prasad Devarajan; Michael R Bennett; Linda Fried; Joachim H Ix; Suzanne Satterfield; Eleanor M Simonsick; Chirag R Parikh; Michael G Shlipak Journal: J Am Soc Nephrol Date: 2014-02-07 Impact factor: 10.121