Chronic kidney disease as a Risk factor for Cardiovascular disease and all-cause mortality: A pooled analysis of community-based studies

Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2004-05, Vol.15 (5), p.1307-1315
Main Authors: WEINER, Daniel E, TIGHIOUART, Hocine, AMIN, Manish G, STARK, Paul C, MACLEOD, Bonnie, GRIFFITH, John L, SALEM, Deeb N, LEVEY, Andrew S, SARNAK, Mark J
Format: Article
Language:English
Subjects:
African Continental Ancestry Group - statistics & numerical data
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular Diseases - ethnology
Cardiovascular Diseases - mortality
European Continental Ancestry Group - statistics & numerical data
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic - ethnology
Kidney Failure, Chronic - mortality
Longitudinal Studies
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Proportional Hazards Models
Risk Factors
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Summary:Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four publicly available, community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were indirectly calibrated across studies. CKD was defined by a GFR between 15 and 60 ml/min per 1.73 m(2). A composite of myocardial infarction, fatal coronary heart disease, stroke, and death was the primary study outcome. Cox proportional hazards models were used to adjust for study, demographic variables, educational status, and other cardiovascular risk factors. The total population included 22,634 subjects; 18.4% of the population was black, and 7.4% had CKD. There were 3262 events. In adjusted analyses, CKD was an independent risk factor for the composite study outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.32), and there was a significant interaction between kidney function and race. Black individuals with CKD had an adjusted HR of 1.76 (95% CI, 1.35-2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02-1.26). CKD is a risk factor for the composite outcome of all-cause mortality and cardiovascular disease in the general population and a more pronounced risk factor in blacks than in whites. It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals.
ISSN:1046-6673
1533-3450
DOI:10.1097/01.ASN.0000123691.46138.E2