Relationship between stage of kidney disease and incident heart failure in older adults.

Pubmed ID: 21734366

Pubmed Central ID: PMC3136373

Journal: American journal of nephrology

Publication Date: Jan. 1, 2011

Affiliation: VA Medical Center, Birmingham, Ala., USA.

MeSH Terms: Humans, Male, Female, Aged, Cohort Studies, Prevalence, Proportional Hazards Models, Heart Failure, Disease Progression, Incidence, Kidney Diseases, Glomerular Filtration Rate

Grants: R01 HL085561, R01-HL085561, R01 HL085561-03S1, R01 HL085561-04, R01 HL097047, R01 HL097047-01, R01 HL097047-02, R01-HL097047, P30 DK079337, R01 DK046199, P30-DK079337, R01-DK046199

Authors: Ekundayo OJ, Love TE, Ahmed A, Mujib M, Anker SD, Pawar PP, Fonarow GC, Zhang Y, Feller MA, Aban IB, Sanders PW, Bowling CB

Cite As: Bowling CB, Feller MA, Mujib M, Pawar PP, Zhang Y, Ekundayo OJ, Aban IB, Love TE, Sanders PW, Anker SD, Fonarow GC, Ahmed A. Relationship between stage of kidney disease and incident heart failure in older adults. Am J Nephrol 2011;34(2):135-41. Epub 2011 Jul 4.

Studies:

Abstract

BACKGROUND: The relationship between stage of chronic kidney disease (CKD) and incident heart failure (HF) remains unclear. METHODS: Of the 5,795 community-dwelling adults ≥65 years in the Cardiovascular Health Study, 5,450 were free of prevalent HF and had baseline estimated glomerular filtration rate (eGFR: ml/min/1.73 m(2)) data. Of these, 898 (16%) had CKD 3A (eGFR 45-59 ml/min/1.73 m(2)) and 242 (4%) had CKD stage ≥3B (eGFR <45 ml/min/1.73 m(2)). Data on baseline proteinuria were not available and 4,310 (79%) individuals with eGFR ≥60 ml/min/1.73 m(2) were considered to have no CKD. Propensity scores estimated separately for CKD 3A and ≥3B were used to assemble two cohorts of 1,714 (857 pairs with CKD 3A and no CKD) and 557 participants (148 CKD ≥3B and 409 no CKD), respectively, balanced on 50 baseline characteristics. RESULTS: During 13 years of follow-up, centrally-adjudicated incident HF occurred in 19, 24 and 38% of pre-match participants without CKD (reference), with CKD 3A [unadjusted hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.20-1.63; p < 0.001] and with CKD ≥3B (HR 3.37; 95% CI 2.71-4.18; p < 0.001), respectively. In contrast, among matched participants, incident HF occurred in 23 and 23% of those with CKD 3A and no CKD, respectively (HR 1.03; 95% CI 0.85-1.26; p = 0.746), and 36 and 28% of those with CKD ≥3B and no CKD, respectively (HR 1.44; 95% CI 1.04-2.00; p = 0.027). CONCLUSIONS: Among community-dwelling older adults, CKD is a marker of incident HF regardless of stage; however, CKD ≥3B, not CKD 3A, has a modest independent association with incident HF.