Kidney function and mortality in octogenarians: Cardiovascular Health Study All Stars

Shani Shastri, Ronit Katz, Dena E. Rifkin, Linda F. Fried, Michelle C. Odden, Carmen A. Peralta, Michel Chonchol, David Siscovick, Michael G. Shlipak, Anne B. Newman, Mark J. Sarnak

Research output: Contribution to journalArticle

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Abstract

Objectives To examine the association between kidney function and all-cause mortality in octogenarians. Design Retrospective analysis of prospectively collected data. Setting Community. Participants Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study (CHS) All Stars participants. Measurements Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (eGFR CR) and cystatin C one-variable (eGFRCYS) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. Results Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between eGFRCR and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m2), the highest (≥75 mL/min per 1.73 m2) and lowest (≤43 mL/min per 1.73 m2) quintiles of eGFRCR were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between eGFRCR and all-cause mortality was linear in those with eGFRCYS of less than 60 mL/min per 1.73 m2, and in the multivariate analyses, the lowest quintile of eGFRCYS (>52 mL/min per 1.73 m2) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m2). Conclusion Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFRCYS and all-cause mortality differed from that observed with eGFRCYS; the relationship was U-shaped for eGFRCR, whereas the risk was primarily present in the lowest quintile for eGFRCYS.

Original languageEnglish (US)
Pages (from-to)1201-1207
Number of pages7
JournalJournal of the American Geriatrics Society
Volume60
Issue number7
DOIs
StatePublished - Jul 2012

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Kidney
Mortality
Health
Cystatin C
Confidence Intervals
Glomerular Filtration Rate
Creatinine
Chronic Renal Insufficiency
Proportional Hazards Models
Diabetes Mellitus
Epidemiology
Cardiovascular Diseases
Multivariate Analysis
Hypertension
Serum

Keywords

  • kidney function
  • mortality
  • octogenarians

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Kidney function and mortality in octogenarians : Cardiovascular Health Study All Stars. / Shastri, Shani; Katz, Ronit; Rifkin, Dena E.; Fried, Linda F.; Odden, Michelle C.; Peralta, Carmen A.; Chonchol, Michel; Siscovick, David; Shlipak, Michael G.; Newman, Anne B.; Sarnak, Mark J.

In: Journal of the American Geriatrics Society, Vol. 60, No. 7, 07.2012, p. 1201-1207.

Research output: Contribution to journalArticle

Shastri, S, Katz, R, Rifkin, DE, Fried, LF, Odden, MC, Peralta, CA, Chonchol, M, Siscovick, D, Shlipak, MG, Newman, AB & Sarnak, MJ 2012, 'Kidney function and mortality in octogenarians: Cardiovascular Health Study All Stars', Journal of the American Geriatrics Society, vol. 60, no. 7, pp. 1201-1207. https://doi.org/10.1111/j.1532-5415.2012.04046.x
Shastri, Shani ; Katz, Ronit ; Rifkin, Dena E. ; Fried, Linda F. ; Odden, Michelle C. ; Peralta, Carmen A. ; Chonchol, Michel ; Siscovick, David ; Shlipak, Michael G. ; Newman, Anne B. ; Sarnak, Mark J. / Kidney function and mortality in octogenarians : Cardiovascular Health Study All Stars. In: Journal of the American Geriatrics Society. 2012 ; Vol. 60, No. 7. pp. 1201-1207.
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abstract = "Objectives To examine the association between kidney function and all-cause mortality in octogenarians. Design Retrospective analysis of prospectively collected data. Setting Community. Participants Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study (CHS) All Stars participants. Measurements Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (eGFR CR) and cystatin C one-variable (eGFRCYS) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. Results Mean age of the participants was 85, 64{\%} were female, 66{\%} had hypertension, 14{\%} had diabetes mellitus, and 39{\%} had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between eGFRCR and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m2), the highest (≥75 mL/min per 1.73 m2) and lowest (≤43 mL/min per 1.73 m2) quintiles of eGFRCR were independently associated with mortality (hazard ratio (HR) = 2.49, 95{\%} confidence interval (CI) = 1.36-4.55; HR = 2.28, 95{\%} CI = 1.26-4.10, respectively). The association between eGFRCR and all-cause mortality was linear in those with eGFRCYS of less than 60 mL/min per 1.73 m2, and in the multivariate analyses, the lowest quintile of eGFRCYS (>52 mL/min per 1.73 m2) was significantly associated with mortality (HR = 2.04, 95{\%} CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m2). Conclusion Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFRCYS and all-cause mortality differed from that observed with eGFRCYS; the relationship was U-shaped for eGFRCR, whereas the risk was primarily present in the lowest quintile for eGFRCYS.",
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T1 - Kidney function and mortality in octogenarians

T2 - Cardiovascular Health Study All Stars

AU - Shastri, Shani

AU - Katz, Ronit

AU - Rifkin, Dena E.

AU - Fried, Linda F.

AU - Odden, Michelle C.

AU - Peralta, Carmen A.

AU - Chonchol, Michel

AU - Siscovick, David

AU - Shlipak, Michael G.

AU - Newman, Anne B.

AU - Sarnak, Mark J.

PY - 2012/7

Y1 - 2012/7

N2 - Objectives To examine the association between kidney function and all-cause mortality in octogenarians. Design Retrospective analysis of prospectively collected data. Setting Community. Participants Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study (CHS) All Stars participants. Measurements Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (eGFR CR) and cystatin C one-variable (eGFRCYS) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. Results Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between eGFRCR and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m2), the highest (≥75 mL/min per 1.73 m2) and lowest (≤43 mL/min per 1.73 m2) quintiles of eGFRCR were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between eGFRCR and all-cause mortality was linear in those with eGFRCYS of less than 60 mL/min per 1.73 m2, and in the multivariate analyses, the lowest quintile of eGFRCYS (>52 mL/min per 1.73 m2) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m2). Conclusion Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFRCYS and all-cause mortality differed from that observed with eGFRCYS; the relationship was U-shaped for eGFRCR, whereas the risk was primarily present in the lowest quintile for eGFRCYS.

AB - Objectives To examine the association between kidney function and all-cause mortality in octogenarians. Design Retrospective analysis of prospectively collected data. Setting Community. Participants Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study (CHS) All Stars participants. Measurements Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (eGFR CR) and cystatin C one-variable (eGFRCYS) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. Results Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between eGFRCR and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m2), the highest (≥75 mL/min per 1.73 m2) and lowest (≤43 mL/min per 1.73 m2) quintiles of eGFRCR were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between eGFRCR and all-cause mortality was linear in those with eGFRCYS of less than 60 mL/min per 1.73 m2, and in the multivariate analyses, the lowest quintile of eGFRCYS (>52 mL/min per 1.73 m2) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m2). Conclusion Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFRCYS and all-cause mortality differed from that observed with eGFRCYS; the relationship was U-shaped for eGFRCR, whereas the risk was primarily present in the lowest quintile for eGFRCYS.

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