Cardiovascular Disease and Subsequent Kidney Disease

Cardiovascular Disease and Subsequent Kidney Disease

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;167:1130-1136.

ABSTRACT

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.

Prognostic Value of the New York Heart Association Classification in End-Stage Renal Disease

Prognostic Value of the New York Heart Association Classification in End-Stage Renal Disease

Maurizio Postorino; Carmen Marino; Giovanni Tripepi; Carmine Zoccali; on behalf of the Calabrian Registry of Dialysis and Transplantation*

Nephrol Dial Transplant. 2007;22(5):1377-1382. ©2007 Oxford University Press


Abstract and Introduction

Abstract

Background:

The New York Heart Association (NYHA) classification is a strong predictor of mortality and an established instrument for risk stratification in patients with heart disease but data on the validity of this classification in end-stage renal disease (ESRD) are sparse.

Methods:

In this study, we tested the predictive value of the NYHA in patients with ESRD and compared it with that of two established indexes of disease severity, i.e. the Khan index and the renal disease severity score (RDSS). The study cohort was composed of 1322 incident patients in a dialysis registry (772 male and 550 female, age 61 ± 16 years).

Results:

During the follow-up period (41 ± 27 months) 551 patients died. A multivariate COX model including the NYHA classification explained 39% of the variation in mortality, a figure almost identical to that of a model based on the RDSS (37%) and superior (P < 0.001) to that provided by the Khan index-based model (32%). The area under the receiver operating characteristic curve of NYHA classification, as related to all-cause mortality, was 0.74 (95% CI: 0.71-0.77, P < 0.001). Again, RDSS had a predictive value for mortality (0.74, 95% CI: 0.72-0.77) identical to that of NYHA and higher than that of the Khan index (0.70, 95% CI: 0.67-0.72).

Conclusion:

The NYHA is a powerful predictor of mortality in ESRD and provides prognostic information equal or superior to that given by other established indexes of disease severity. Given the pervasive nature of cardiovascular disease in ESRD, this classification may be recommended for risk stratification in this population.

More:

Link: http://www.medscape.com/viewarticle/557267_print