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Am J Kidney Dis. 2008 Feb;51(2):212-23. doi: 10.1053/j.ajkd.2007.10.035.

The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD.

Author information

1
Division of Nephrology, Tufts-New England Medical Center, Boston, MA 02111, USA. dweiner@tufts-nemc.org

Abstract

BACKGROUND:

Chronic kidney disease is associated with increased risk for cardiovascular disease and mortality. Both traditional and nontraditional cardiovascular disease risk factors may contribute.

STUDY DESIGN:

Cohort.

SETTINGS & PARTICIPANTS:

Community-based adult population of the Atherosclerosis Risk in Communities and Cardiovascular Health Studies with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m(2).

PREDICTORS:

Nontraditional cardiovascular disease risk factors, including body mass index, diastolic blood pressure, and triglyceride, albumin, uric acid, fibrinogen, C-reactive protein, and hemoglobin levels.

OUTCOMES:

Composite of myocardial infarction, stroke, and all-cause mortality. Secondary outcomes included individual components of the composite.

RESULTS:

Of 1,678 individuals with decreased eGFR (mean, 51.1 +/- 8.5 mL/min/1.73 m(2)), 891 (53%) reached the composite end point during a median follow-up of 108 months; 23% had a cardiac event, 45% died, and 14% experienced a stroke. Serum albumin level less than 3.9 g/dL (hazard ratio, 0.68 for every 0.3-g/dL decrease; 95% confidence interval, 0.60 to 0.77), increased serum triglyceride level (hazard ratio, 1.07 for every 50-mg/dL increase; 95% confidence interval, 1.02 to 1.12), C-reactive protein level (hazard ratio, 1.15 per log-unit increase; 95% confidence interval, 1.07 to 1.24), and fibrinogen level (hazard ratio, 1.12 per 50-mg/dL increase; 95% confidence interval, 1.07 to 1.18) independently predicted composite events. Both decreased (<14.5 g/dL) and increased (>14.5 g/dL) hemoglobin levels predicted composite events. Serum albumin level less than 3.9 g/dL and increased serum fibrinogen level independently predicted cardiac events. For serum albumin and hemoglobin levels, the relationship with composite and mortality outcomes was nonlinear (P < 0.001).

LIMITATIONS:

Single assessment of eGFR. No albuminuria data.

CONCLUSIONS:

Several nontraditional cardiovascular disease risk factors predict adverse outcomes in individuals with stage 3 to 4 chronic kidney disease. The relationship between risk factors and outcomes is often nonlinear.

PMID:
18215699
PMCID:
PMC4083633
DOI:
10.1053/j.ajkd.2007.10.035
[Indexed for MEDLINE]
Free PMC Article

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