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J Am Geriatr Soc. 2012 Jul;60(7):1201-7. doi: 10.1111/j.1532-5415.2012.04046.x. Epub 2012 Jun 21.

Kidney function and mortality in octogenarians: Cardiovascular Health Study All Stars.

Author information

  • 1Division of Nephrology, University of Texas Southwestern, Dallas, Texas 75390, USA. Shani.Shastri@UTSouthwestern.edu

Abstract

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 (eGFR(CR) ) and cystatin C one-variable (eGFR(CYS) ) 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 eGFR(CR) and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m(2) ), the highest (≥ 75 mL/min per 1.73 m(2) ) and lowest (≤ 43 mL/min per 1.73 m(2) ) quintiles of eGFR(CR) 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 eGFR(CYS) and all-cause mortality was linear in those with eGFR(CYS) of less than 60 mL/min per 1.73 m(2) , and in the multivariate analyses, the lowest quintile of eGFR(CYS) (<52 mL/min per 1.73 m(2) ) 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 m(2) ).

CONCLUSION:

Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFR(CR) and all-cause mortality differed from that observed with eGFR(CYS) ; the relationship was U-shaped for eGFR(CR) , whereas the risk was primarily present in the lowest quintile for eGFR(CYS) .

© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

PMID:
22724391
[PubMed - indexed for MEDLINE]
PMCID:
PMC3902776
Free PMC Article

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