 |
|
Independent Components of Chronic Kidney Disease as a Cardiovascular Risk StateResults From the Kidney Early Evaluation Program (KEEP)
Peter A. McCullough, MD, MPH;
Claudine T. Jurkovitz, MD;
Pablo E. Pergola, MD, PhD;
Janet B. McGill, MD;
Wendy W. Brown, MD;
Alan J. Collins, MD;
Shu-Cheng Chen, MS;
Suying Li, PhD;
Ajay Singh, MD;
Keith C. Norris, MD;
Michael J. Klag, MD;
George L. Bakris, MD; for the KEEP Investigators
Arch Intern Med. 2007;167(11):1122-1129.
Background The relationships of anemia, microalbuminuria, and estimated glomerular filtration rate (eGFR) with cardiovascular disease (CVD) and subsequent death are not fully understood. We hypothesized that each of these chronic kidney disease–related measures would have an independent relationship with CVD.
Methods A cohort of 37 153 persons screened in the National Kidney Foundation's Kidney Early Evaluation Program were followed up for a median of 16.0 months (range, 0.2-47.5 months). Participants were volunteers who completed surveys regarding past medical events and who underwent blood pressure and laboratory testing. Estimated glomerular filtration rate was computed using a 4-variable equation. Mortality was ascertained by linkage to national data systems.
Results Of 37 153 persons, the mean ± SD age was 52.9 ± 15.9 years, and 68.7% were female. A total of 1835 (4.9%) had a self-reported history of myocardial infarction, 1336 (3.6%) had a history of stroke, and 2897 (7.8%) had a history of myocardial infarction or stroke. Multivariate analysis controlling for age demonstrated that the following were independently associated with CVD: male sex (odds ratio [OR], 1.64; P<.001), smoking (OR, 1.73; P<.001), body mass index (OR, 1.01; P = .03), diabetes mellitus (OR, 1.66; P<.001), hypertension (OR, 1.77; P<.001), eGFR of 30 to 59 mL/min per 173 m3 (OR, 1.37; P = .001), hemoglobin level of 12.8 g/dL or less (OR, 1.45; P<.001), and microalbuminuria of greater than 30 mg/L (OR, 1.28; P = .01). Survival analysis found CVD (OR, 3.02; P = .003), chronic kidney disease (OR, 1.98; P = .05), and the combination (OR, 3.80; P<.001) to be independent predictors of mortality. Persons with a combination of all 3 chronic kidney disease measures (anemia, microalbuminuria, and eGFR of <60 mL/min per 1.73 m2) had the lowest survival of about 93% by the end of 30 months.
Conclusion Anemia, eGFR, and microalbuminuria were independently associated with CVD, and when all 3 were present, CVD was common and survival was reduced.
Author Affiliations: Divisions of Cardiology, Nutrition, and Preventive Medicine, Department of Medicine, William Beaumont Hospital, Royal Oak, Mich (Dr McCullough); Center for Outcomes Research, Christiana Care Health System, Newark, Del (Dr Jurkovitz); Division of Nephrology, Department of Medicine, The University of Texas Health Science Center, San Antonio (Dr Pergola); Division of Endocrinology, Department of Medicine, Washington University School of Medicine, St Louis, Mo (Dr McGill); Department of Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, Ill (Dr Brown); Division of Nephrology, Department of Medicine, USRDS Coordinating Center, Minneapolis, Minn (Drs Collins and Li and Mr Chen); Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass (Dr Singh); Department of Medicine, Charles R. Drew University of Medicine and Science, Lynwood, Calif (Dr Norris); The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (Dr Klag); and Divisions of Preventive Medicine, Hypertension, and Nephrology, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago (Dr Bakris).
Group Information: A complete list of the KEEP Investigators was published in KEEP 2005 Annual Data Report, New York, NY: National Kidney Foundation; 2005:s8.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED ARTICLE
Chronic Kidney Disease: Cause and Consequence of Cardiovascular Disease
Barry I. Freedman and Thomas D. DuBose, Jr
Arch Intern Med. 2007;167(11):1113-1115.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Blood Pressure-Independent Reduction in Proteinuria and Arterial Stiffness After Acute Endothelin-A Receptor Antagonism in Chronic Kidney Disease
Dhaun et al.
Hypertension 2009;54:113-119.
ABSTRACT
| FULL TEXT
Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study
Kurth et al.
BMJ 2009;338:b2392-b2392.
ABSTRACT
| FULL TEXT
The scope of coronary heart disease in patients with chronic kidney disease.
Hage et al.
J Am Coll Cardiol 2009;53:2129-2140.
ABSTRACT
| FULL TEXT
Glomerular filtration rate is related to carotid intima-media thickness in middle-aged adults
Kastarinen et al.
Nephrol Dial Transplant 2009;0:gfp172v1-gfp172.
ABSTRACT
| FULL TEXT
Investigating the effect of genetic background on proteinuria and renal injury using two hypertensive strains
Packard et al.
Am. J. Physiol. Renal Physiol. 2009;296:F839-F846.
ABSTRACT
| FULL TEXT
Chronic Kidney Disease and Clinical Outcome in Patients With Acute Stroke
Yahalom et al.
Stroke 2009;40:1296-1303.
ABSTRACT
| FULL TEXT
The message for World Kidney Day 2009: Hypertension and kidney disease: a marriage that should be prevented
Bakris et al.
Nephrol Dial Transplant 2009;24:695-697.
FULL TEXT
The Message for World Kidney Day 2009: Hypertension and Kidney Disease: A Marriage that Should Be Prevented
Bakris et al.
CJASN 2009;4:517-519.
FULL TEXT
Cardiovascular disease in chronic kidney disease
Saran and DuBose
Ther Adv Cardiovasc Dis 2008;2:425-434.
ABSTRACT
A genome-wide search for linkage to chronic kidney disease in a community-based sample: the SAFHS
Arar et al.
Nephrol Dial Transplant 2008;23:3184-3191.
ABSTRACT
| FULL TEXT
Validation and Comparison of a Novel Screening Guideline for Kidney Disease: KEEPing SCORED
Bang et al.
Arch Intern Med 2008;168:432-435.
FULL TEXT
Chronic Kidney Disease: Cause and Consequence of Cardiovascular Disease
Freedman and DuBose
Arch Intern Med 2007;167:1113-1115.
FULL TEXT
|
