Document Detail

Chronic kidney disease, prevalence of premature cardiovascular disease, and relationship to short-term mortality.
MedLine Citation:
PMID:  18657657     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chronic kidney disease (CKD) is recognized as an independent cardiovascular disease (CVD) risk state, particularly in the elderly, and has been defined by levels of estimated glomerular filtration rate (eGFR) and markers of kidney damage. The relationship between CKD and CVD in younger and middle-aged adults has not been fully explored. METHODS: Community volunteers completed surveys regarding past medical events and underwent blood pressure and laboratory testing. Chronic kidney disease was defined as an eGFR <60 mL x min(-1) x 1.73 m(-2) or urine albumin-creatinine ratio (ACR) > or =30 mg/g. Premature CVD was defined as self-reported myocardial infarction or stroke at <55 years of age in men and <65 years of age in women. Mortality was ascertained by linkage to national data systems. RESULTS: Of 31 417 participants, the mean age was 45.1 +/- 11.2 years, 75.5% were female, 36.8% African American, and 21.6% had diabetes. A total of 20.6% were found to have CKD, with the ACR and eGFR being the dominant positive screening tests in the younger and older age deciles, respectively. The prevalences of premature myocardial infarction (MI), stroke, or death, and the composite were 5.3%, 4.7%, 0.8%, 9.2%, and 2.5%, 2.2%, 0.2%, 4.2% for those with and without CKD, respectively (P < .0001 for composite). Multivariable analysis found CKD (OR 1.44, 95% CI 1.27-1.63), age (OR 1.05 [per year], 95% CI 1.04-1.06), hypertension (OR 1.61, 95% CI 1.40-1.84), diabetes (OR 2.03, 95% CI 1.79-2.29), smoking (OR 1.91, 95% CI 1.66-2.21), and less than high school education (OR 1.59, 95% CI 1.37-1.85) as the most significantly associated factors for premature CVD or death (all P < .0001). Survival analysis found those with premature MI or stroke and CKD had the poorest short-term survival over the next 3 years after screening. CONCLUSIONS: Chronic kidney disease is an independent predictor of MI, stroke, and death among men and women younger than age 55 and 65 years, respectively. These data suggest the biologic changes that occur with kidney failure promote CVD at an accelerated rate that cannot be fully explained by conventional risk factors or older age. Screening for CKD by using both the ACR and eGFR can identify younger and middle-aged individuals at high risk for premature CVD and near-term death.
Peter A McCullough; Suying Li; Claudine T Jurkovitz; Leslie Stevens; Alan J Collins; Shu-Cheng Chen; Keith C Norris; Samy McFarlane; Bruce Johnson; Michael G Shlipak; Chamberlain I Obialo; Wendy W Brown; Joseph Vassalotti; Joseph Vassaloti; Adam T Whaley-Connell; Robert M Brenner; George L Bakris;
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Publication Detail:
Type:  Journal Article     Date:  2008-06-04
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-28     Completed Date:  2008-08-05     Revised Date:  2008-12-16    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  277-83     Citation Subset:  AIM; IM    
Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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MeSH Terms
Glomerular Filtration Rate
Kaplan-Meiers Estimate
Kidney Failure, Chronic / complications*,  mortality
Middle Aged
Multivariate Analysis
Myocardial Infarction / etiology*
Risk Factors
Stroke / etiology*
Erratum In:
Am Heart J. 2008 Dec;156(6):1132
Note: Vassaloti, Joseph [corrected to Vassalotti, Joseph]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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