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Previous Volume 351:1296-1305 September 23, 2004 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Hostetter, T. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined.

Methods We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation. We examined the multivariable association between the estimated GFR and the risks of death, cardiovascular events, and hospitalization.

Results The median follow-up was 2.84 years, the mean age was 52 years, and 55 percent of the group were women. After adjustment, the risk of death increased as the GFR decreased below 60 ml per minute per 1.73 m² of body-surface area: the adjusted hazard ratio for death was 1.2 with an estimated GFR of 45 to 59 ml per minute per 1.73 m² (95 percent confidence interval, 1.1 to 1.2), 1.8 with an estimated GFR of 30 to 44 ml per minute per 1.73 m² (95 percent confidence interval, 1.7 to 1.9), 3.2 with an estimated GFR of 15 to 29 ml per minute per 1.73 m² (95 percent confidence interval, 3.1 to 3.4), and 5.9 with an estimated GFR of less than 15 ml per minute per 1.73 m² (95 percent confidence interval, 5.4 to 6.5). The adjusted hazard ratio for cardiovascular events also increased inversely with the estimated GFR: 1.4 (95 percent confidence interval, 1.4 to 1.5), 2.0 (95 percent confidence interval, 1.9 to 2.1), 2.8 (95 percent confidence interval, 2.6 to 2.9), and 3.4 (95 percent confidence interval, 3.1 to 3.8), respectively. The adjusted risk of hospitalization with a reduced estimated GFR followed a similar pattern.

Conclusions An independent, graded association was observed between a reduced estimated GFR and the risk of death, cardiovascular events, and hospitalization in a large, community-based population. These findings highlight the clinical and public health importance of chronic renal insufficiency.

Source Information

From the Division of Research, Kaiser Permanente of Northern California, Oakland (A.S.G., D.F.); and the Departments of Epidemiology and Biostatistics (A.S.G., G.M.C., C.E.M.) and Medicine (A.S.G., G.M.C., C.-y.H.), University of California, San Francisco, San Francisco.

Address reprint requests to Dr. Go at the Division of Research, Kaiser Permanente of Northern California, 2000 Broadway, 3rd Fl., Oakland, CA 94612-2304, or at alan.s.go{at}kp.org.

Full Text of this Article

Related Letters:

Chronic Renal Disease and Cardiovascular Risk
Risch L., Sagmeister M., Huber A., Cheng H., Go A. S., Chertow G. M., Hsu C.-y., Anavekar N. S., McMurray J. J.V., Pfeffer M. A.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:199-200, Jan 13, 2005. Correspondence

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• Hsu, C.-y., Chertow, G. M., McCulloch, C. E., Fan, D., Ordonez, J. D., Go, A. S. (2009). Nonrecovery of Kidney Function and Death after Acute on Chronic Renal Failure. CJASN 4: 891-898 [Abstract] [Full Text]  
• Madero, M., Wassel, C. L., Peralta, C. A., Najjar, S. S., Sutton-Tyrrell, K., Fried, L., Canada, R., Newman, A., Shlipak, M. G., Sarnak, M. J., for the Health ABC Study, (2009). Cystatin C Associates with Arterial Stiffness in Older Adults. J. Am. Soc. Nephrol. 20: 1086-1093 [Abstract] [Full Text]  
• Connor, A (2009). Novel therapeutic agents and strategies for the management of chronic kidney disease mineral and bone disorder. Postgrad. Med. J. 85: 274-279 [Abstract] [Full Text]  
• Yokoyama, H., Sone, H., Oishi, M., Kawai, K., Fukumoto, Y., Kobayashi, M., on behalf of Japan Diabetes Clinical Data Manageme, (2009). Prevalence of albuminuria and renal insufficiency and associated clinical factors in type 2 diabetes: the Japan Diabetes Clinical Data Management study (JDDM15). Nephrol Dial Transplant 24: 1212-1219 [Abstract] [Full Text]  
• Pizzarelli, F., Lauretani, F., Bandinelli, S., Windham, G. B., Corsi, A. M., Giannelli, S. V., Ferrucci, L., Guralnik, J. M. (2009). Predictivity of survival according to different equations for estimating renal function in community-dwelling elderly subjects. Nephrol Dial Transplant 24: 1197-1205 [Abstract] [Full Text]  
• Reinecke, H., Brand, E., Mesters, R., Schabitz, W.-R., Fisher, M., Pavenstadt, H., Breithardt, G. (2009). Dilemmas in the Management of Atrial Fibrillation in Chronic Kidney Disease. J. Am. Soc. Nephrol. 20: 705-711 [Abstract] [Full Text]  
• van der Velde, M., Halbesma, N., de Charro, F. T., Bakker, S. J.L., de Zeeuw, D., de Jong, P. E., Gansevoort, R. T. (2009). Screening for Albuminuria Identifies Individuals at Increased Renal Risk. J. Am. Soc. Nephrol. 20: 852-862 [Abstract] [Full Text]  
• Noiri, E., Doi, K., Negishi, K., Tanaka, T., Hamasaki, Y., Fujita, T., Portilla, D., Sugaya, T. (2009). Urinary fatty acid-binding protein 1: an early predictive biomarker of kidney injury. Am. J. Physiol. Renal Physiol. 296: F669-F679 [Abstract] [Full Text]  
• Go, A. S., Fang, M. C., Udaltsova, N., Chang, Y., Pomernacki, N. K., Borowsky, L., Singer, D. E., for the ATRIA Study Investigators, (2009). Impact of Proteinuria and Glomerular Filtration Rate on Risk of Thromboembolism in Atrial Fibrillation: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Circulation 119: 1363-1369 [Abstract] [Full Text]  
• Peralta, C. A., Katz, R., Madero, M., Sarnak, M., Kramer, H., Criqui, M. H., Shlipak, M. G. (2009). The Differential Association of Kidney Dysfunction With Small and Large Arterial Elasticity: The Multiethnic Study of Atherosclerosis. Am J Epidemiol 169: 740-748 [Abstract] [Full Text]  
• Diez, C., Mohr, P., Kuss, O., Osten, B., Silber, R.-E., Hofmann, H.-S. (2009). Impact of Preoperative Renal Dysfunction on In-hospital Mortality After Solitary Valve and Combined Valve and Coronary Procedures.. Ann. Thorac. Surg. 87: 731-736 [Abstract] [Full Text]  
• Asselbergs, F. W., Mozaffarian, D., Katz, R., Kestenbaum, B., Fried, L. F., Gottdiener, J. S., Shlipak, M. G., Siscovick, D. S. (2009). Association of renal function with cardiac calcifications in older adults: the cardiovascular health study. Nephrol Dial Transplant 24: 834-840 [Abstract] [Full Text]  
• Thilly, N., Boini, S., Kessler, M., Briancon, S., Frimat, L. (2009). Management and control of hypertension and proteinuria in patients with advanced chronic kidney disease under nephrologist care or not: data from the AVENIR study (AVantagE de la Nephroprotection dans l'Insuffisance Renale). Nephrol Dial Transplant 24: 934-939 [Abstract] [Full Text]