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Kidney Function and Mortality in Octogenarians: Cardiovascular Health Study All Stars

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https://ir.library.oregonstate.edu/concern/articles/z890rv037

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  • 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[subscript CR]) and cystatin C one-variable (eGFR[subscript CYS]) 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 eGFR[subscript CR] 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 eGFR[subscript CR] 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 eGFR[subscript CYS] and all-cause mortality was linear in those with eGFR[subscript CYS] of less than 60 mL/min per 1.73 m², and in the multivariate analyses, the lowest quintile of eGFR[subscript CYS] (<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 eGFR[subscript CR] and all-cause mortality differed from that observed with eGFR[subscript CYS]; the relationship was U-shaped for eGFR[subscript CR], whereas the risk was primarily present in the lowest quintile for eGFR[subscript CYS].
  • This is the publisher’s final pdf. The article is copyrighted by The American Geriatrics Society and published by John Wiley & Sons, Inc. It can be found at: http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291532-5415/
  • Keywords: mortality, kidney function, octogenarians
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  • Shastri, S., Katz, R., Rifkin, D. E., Fried, L. F., Odden, M. C., Peralta, C. A., Chonchol, M., Siscovick, D., Shlipak, M. G., Newman, A. B. and Sarnak, M. J. (2012), Kidney Function and Mortality in Octogenarians: Cardiovascular Health Study All Stars. Journal of the American Geriatrics Society, 60: 1201–1207. doi: 10.1111/j.1532-5415.2012.04046.x
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  • 60
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  • 7
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  • The research reported in this article was supported by National Institute on Aging (NIA) Grant AG-023629. CHS was supported by National Heart, Lung, and Blood Institute (NHLBI) Contracts N01-HC-85239, N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01-HC-15103, N01-HC-55222, N01-HC-75150, and N01-HC-45133 and NHLBI Grant HL080295, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided through AG-023629, AG-15928, AG-20098, and AG-027058 from the NIA. A full list of principal CHS investigators and institutions can be found at http://www.chsnhlbi.org/pi.htm. This material is also based on work supported in part by the Department of Veterans Affairs, Veterans Integrated Service Network 4, R01-HL-075366 from the National Heart, Lung and Blood Institute, and the University of Pittsburgh Claude. D. Pepper Older Americans Independence Center P30-AG-024827. Dr. Sarnak is supported by K24 DK078204.
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