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Essam F. Elsayed, MD; Hocine Tighiouart, MS; John Griffith, PhD; Tobias Kurth, MD, ScD; Andrew S. Levey, MD; Deeb Salem, MD; Mark J. Sarnak, MD, MS; Daniel E. Weiner, MD, MS

Arch Intern Med. 2007;167(11):1130-1136.

Background  Chronic kidney disease is a risk factor for cardiovascular disease (CVD); however, it is uncertain if CVD is a risk factor for progression or development of kidney disease.

Methods  Individual patient data were pooled from 2 longitudinal, community-based, limited-access studies, the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. Baseline CVD was defined by stroke, angina, claudication, transient ischemic attack, coronary angioplasty or bypass, and recognized or silent myocardial infarction. Study outcomes included kidney function decline, defined by an increase in serum creatinine level of at least 0.4 mg/dL (35.4 µmol/L), and development of kidney disease, defined by an increase in serum creatinine level of at least 0.4 mg/dL (35.4 µmol/L) in which the baseline serum creatinine level was less than 1.4 mg/dL (<123.8 µmol/L) in men and less than 1.2 mg/dL (<106.1 µmol/L) in women and the final serum creatinine levels exceeded these levels. Secondarily, kidney function decline was defined by an estimated glomerular filtration rate (eGFR) reduction of at least 15 mL/min per 1.73 m², and development of kidney disease was defined by an eGFR reduction of at least 15 mL/min per 1.73 m² in which the baseline eGFR was at least 60 mL/min per 1.73 m² and the final eGFR was below these levels. Multivariate logistic regression analysis was used to determine the association between CVD and outcomes.

Results  Among 13 826 individuals, the mean ± SD baseline serum creatinine level was 0.9 ± 0.2 mg/dL (79.6 ± 17.7 µmol/L), and the mean ± SD baseline eGFR was 89.8 ± 20.1 mL/min per 1.73 m². In serum creatinine level–based models, 520 individuals (3.8%) experienced kidney function decline, and 314 individuals (2.3%) developed kidney disease during a mean ± SD of 9.3 ± 0.9 years of follow-up. Baseline CVD, present in 1787 individuals (12.9%), was associated with an increased risk of all outcomes (odds ratio, 1.70; 95% confidence interval, 1.36-2.13), an odds ratio of 1.75 (95% confidence interval, 1.32-2.32) for serum creatinine level, and odds ratios of 1.28 (95% confidence interval, 1.13-1.45) and 1.54 (95% confidence interval, 1.26-1.89) for eGFR for kidney function decline and development of kidney disease, respectively.

Conclusion  Cardiovascular disease is independently associated with kidney function decline and with the development of kidney disease.

Author Affiliations: Divisions of Nephrology (Drs Elsayed, Levey, Sarnak, and Weiner) and Cardiology (Dr Salem), Department of Medicine, and Biostatistics Research Center (Mr Tighiouart and Dr Griffith), Tufts–New England Medical Center, and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital (Dr Kurth), Boston, Mass.

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