The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years.
Department of Internal Medicine, Renal Division, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
AIMS: Moderate-to-severe chronic renal failure is an established risk factor for cardiovascular disease and mortality.
However, most studies have been performed in selected populations and the impact of very small decrements of renal function on long-term cardiac morbidity and mortality has not yet been established.
Also, the cut-off level of glomerular filtration rate (GFR) from which cardiovascular risk increases has not exactly been established. This study wants to address these questions.
METHODS AND RESULTS: Ten year follow-up of a representative population-based cohort comprised 8913 randomly selected, apparently healthy participants. Participants were randomly drawn from Belgian voting lists. Cardiovascular risk factors were noted.
Serum creatinine values were corrected to isotope dilution mass spectrometry standard, and GFR was calculated using the recently modified 'modification of diet in renal disease' equation.
Participants were followed for 10 years, and cause-specific death was registered by analysis of death certificates.
The probability to die from all causes or from cardiovascular causes during the 10 year follow-up period increased in each quartile of GFR, even after correction for different other comorbid conditions.
CONCLUSION: Even mild renal failure is an independent risk factor for cardiovascular mortality within 10 years in an apparently healthy unselected population.
This detrimental effect starts already at a relatively high GFR of 90 mL/min/1.73 m(2) and remains present after correction for other established cardiovascular risk factors.
----------------------------A similar study published earlier
----------------------------
Kidney Int. 2002 Oct;62(4):1402-7.
Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study.
Institute for Research in Extramural Medicine, Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
BACKGROUND: Cardiovascular mortality is extremely high in end-stage renal disease. Cardiovascular mortality risk also is increased in selected (high-risk) individuals with mild to moderate impairment of renal function.
It is not clear whether a similar association exists in the general population and, if so, through what mechanisms. We investigated the association of renal function with all-cause and cardiovascular mortality in a population-based cohort and explored potential mechanisms underlying any such relationship.
METHODS: An age-, sex-, and glucose-tolerance-stratified sample (N = 631) of a population-based cohort aged 50 to 75 years was followed prospectively. After up to 10.2 years of follow-up, 117 subjects had died (50 of cardiovascular causes).
At baseline, renal function was estimated by the serum creatinine level, the Cockcroft-Gault formula and Levey's equation.
RESULTS: At baseline, the mean age was 64 +/- 7 years, 48% were men, 55% had hypertension, and 27% (by design) had type 2 diabetes.
- Serum creatinine was 91.7 +/- 19.0 micromol/L;
- creatinine clearance as estimated by the Cockroft-Gault formula was 72.5 +/- 13.7 mL/min/1.73 m(2),
- glomerular filtration rate (GFR) estimated by Levey's equation was 67.8 +/- 12.1 mL/min/1.73 m(2).
Relative risks (95% confidence intervals) were
- 1.08 (1.04 to 1.13) and 1.11 (1.07 to 1.16) per 5 micromol/L increase of serum creatinine;
- 1.07 (0.98 to 1.17) and 1.15 (1.01 to 1.31) for each decrease of 5 mL/min/1.73 m(2) creatinine clearance;
- 1.15 (1.05 to 1.26) and 1.26 (1.12 to 1.42) for each decrease of 5 mL/min/1.73 m(2) of GFR.
Analyses in diabetic and hypertensive subjects gave similar results.
CONCLUSION: Mild to moderate loss of renal function is strongly associated with an increased risk of cardiovascular mortality.
The mechanism behind this association is unclear but does not appear to involve common risk factors such as hypertension, diabetes or hyperhomocysteinemia.
Estimation of renal function by relatively simple methods therefore may be a valuable tool for cardiovascular risk assessment over and above that provided by conventional risk factors.
Our results were obtained in a general middle-aged to elderly population, and thus have broad applicability.
No comments:
Post a Comment