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