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

• Autores: 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
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 60, Nº. 7, 2012, págs. 1201-1207
• Idioma: inglés
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• Resumen

  • 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 (eGFRCR) 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 eGFRCYS 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 eGFRCR 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.