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The Framingham Heart Study

Bruce F. Culleton, MD; Martin G. Larson, ScD; Jane C. Evans, MPH; Peter W. F. Wilson, MD; Brendan J. Barrett, MD; Patrick S. Parfrey, MD; Daniel Levy, MD

Arch Intern Med. 1999;159:1785-1790.

Background  Elevated serum creatinine (SCr) levels are a predictor of end-stage renal disease, but little is known about the prevalence of elevated SCr levels and their correlates in the community.

Methods  In this cross-sectional, community-based sample, SCr levels were measured in 6233 adults (mean age, 54 years; 54% women) who composed the "broad sample" of this investigation. A subset, consisting of 3241 individuals who were free of known renal disease, cardiovascular disease, hypertension, and diabetes, constituted the healthy reference sample. In this latter sample, sex-specific 95th percentiles for SCr levels (men, 136 µmol/L [1.5 mg/dL]; women, 120 µmol/L [1.4 mg/dL]) were labeled cutpoints. These cutpoints were applied to the broad sample in a logistic regression model to identify prevalence and correlates of elevated SCr levels.

Results  The prevalence of elevated SCr levels was 8.9% in men and 8.0% in women. Logistic regression in men identified age, treatment for hypertension (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.27-2.42), and body mass index (OR, 1.08; 95% CI, 1.01-1.15) as correlates of elevated SCr levels. Additionally, men with diabetes who were receiving antihypertensive medication were more likely to have raised SCr values (OR, 2.94; 95% CI, 1.60-5.39). In women, age, use of cardiac medications (OR, 1.58; 95% CI, 1.10-2.96), and treatment for hypertension (OR, 1.42; 95% CI, 1.07-1.87) were associated with elevated SCr levels.

Conclusions  Elevated SCr levels are common in the community and are strongly associated with older age, treatment for hypertension, and diabetes. Longitudinal studies are warranted to determine the clinical outcomes of individuals with elevated levels of SCr and to examine factors related to the progression of renal disease in the community.

From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass (Drs Culleton, Larson, Wilson, and Levy and Ms Evans); the Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Mass (Dr Larson and Ms Evans); and the Division of Nephrology, Memorial University of Newfoundland, St John's (Drs Barrett and Parfrey).

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