Estimated GFR and Incident Cardiovascular Disease Events in American Indians: The Strong Heart Study

Shara, Nawar; Wang, Hong; Méte, Mihriye; Al-Balha, Yaman Rai; Azalddin, Nameer; Lee, Elisa T.; Franceschini, Nora; Jolly, Stacey E.; Howard, Barbara V.; Umans, Jason G.

doi:10.1053/j.ajkd.2012.06.015

Cited by 29 publications

(35 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, pulmonary capillary wedge pressure is mainly determined by the filling pressure in the left heart chambers, which is influenced by systolic and diastolic dysfunction, both conditions being highly prevalent among CKD patients [37] . In our study, we found a higher prevalence of systolic and diastolic dysfunction among PH patients, highlighting the main role that this entity may have in the development of PH.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Hypertension Is Associated with Mortality and Cardiovascular Events in Chronic Kidney Disease Patients

Reque

García‐Prieto²,

Liñares³

et al. 2016

Am J Nephrol

View full text Add to dashboard Cite

Background: We evaluated the prevalence, determinants and prognosis value of pulmonary hypertension (PH) in non-dialysis chronic kidney disease (CKD) patients. Methods: This is a prospective study with stages 3-5 non-dialysis-dependent CKD patients. PH was estimated by Doppler echocardiography and defined as a pulmonary artery systolic pressure above 35 mm Hg. Results: Three hundred fifty-three patients were recruited, of whom 94 (26.6%) had PH. Prevalence of PH increased with the decline of renal function: 21.6, 24.1, and 31.7% in stages 3, 4, and 5, respectively. Independent predictors of PH were age, estimated glomerular filtration rate (eGFR), history of cardiovascular (CV) events, the presence of an arteriovenous fistulae (AVF), and left ventricular (systolic and diastolic) dysfunction. Over a median follow-up of 22 months, 71 patients died (20%). After multivariate adjustment for age, gender, previous CV disease, diastolic and systolic dysfunction, PH remained as an independent predictor of all-cause mortality (hazards ratio [HR] 1.84, 95% CI 1.06-3.18, p = 0.02). One hundred patients (28%) had a new onset CV event. After adjustment for age, gender, previous CV disease, systolic and diastolic dysfunction, PH maintains its independent association with CV events (HR 2.77, 95% CI 2.00-3.25, p < 0.001). Conclusions: PH prevalence rises as kidney function declines. Main determinants of PH are age, eGFR, previous CV disease, the presence of an AVF and left ventricular systolic or diastolic dysfunction. PH is an independent predictor of all-cause mortality and CV events.

show abstract

Section: Discussionmentioning

confidence: 99%

Pulmonary Hypertension Is Associated with Mortality and Cardiovascular Events in Chronic Kidney Disease Patients

Reque

García‐Prieto²,

Liñares³

et al. 2016

Am J Nephrol

View full text Add to dashboard Cite

show abstract

“…Estimated glomerular filtration rate (eGFR) was calculated from recalibrated creatinine, age and sex using the Chronic Kidney Disease Epidemiology Collaboration formula. 24, 25 …”

Section: Methodsmentioning

confidence: 99%

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

Mateen

Grau-Pérez

Pollak

et al. 2017

Environmental Research

Self Cite

View full text Add to dashboard Cite

Background Inorganic arsenic exposure from naturally contaminated groundwater is related to vascular disease. No prospective studies have evaluated the association between arsenic and carotid atherosclerosis at low-moderate levels. We examined the association of long-term, low-to-moderate inorganic arsenic exposure with carotid arterial disease. Methods American Indians, 45 to 74 years old, in Arizona, Oklahoma, and North and South Dakota had arsenic concentrations (sum of inorganic and methylated species, μg/g urine creatinine) measured from baseline urine samples (1989-1991). Carotid artery ultrasound was performed in 1998-1999. Vascular disease was assessed by the carotid intima media thickness (CIMT), the presence of atherosclerotic plaque in the carotid, and by the number of segments containing plaque (plaque score). Results 2402 participants (mean age 55.3 years, 63.1% female, mean body mass index 31.0kg/m2, diabetes 45.7%, hypertension 34.2%) had a median (interquintile range) urine arsenic concentration of 9.2 (5.00, 17.06) μg/g creatinine. The mean CIMT was 0.75 mm. 64.7% had carotid artery plaque (3% with >50% stenosis). In fully adjusted models comparing participants in the 80th vs. 20th percentile in arsenic concentrations, the mean difference in CIMT was 0.01 (95% confidence interval (95%CI): 0.00, 0.02) mm, the relative risk of plaque presence was 1.04 (95%CI: 0.99, 1.09), and the geometric mean ratio of plaque score was 1.05 (95%CI: 1.01, 1.09). Conclusions Urine arsenic was positively associated with CIMT and increased plaque score later in life although the association was small. The relationship between urinary arsenic and the presence of plaque was not statistically significant when adjusted for other risk factors. Arsenic exposure may play a role in increasing the severity of carotid vascular disease.

show abstract

“…27 eGFR was calculated from creatinine, age, and sex using the Modification of Diet in Renal Disease equation without the ethnicity factor. 28 Prevalent CKD was defined as eGFR ≤60 ml/min/1.73 m 2 or presence of kidney transplant or dialysis at baseline.…”

Section: Methodsmentioning

confidence: 99%

The Association of Urine Arsenic with Prevalent and Incident Chronic Kidney Disease

et al. 2015

Self Cite

View full text Add to dashboard Cite

Background Few studies have evaluated associations between low to moderate arsenic levels and chronic kidney disease (CKD). The objective was to evaluate the associations of inorganic arsenic exposure with prevalent and incident CKD in American Indian adults. Methods We evaluated the associations of inorganic arsenic exposure with CKD in American Indians who participated in the Strong Heart Study (SHS) in 3,851 adults aged 45–74 years in a cross-sectional analysis, and 3,119 adults with follow-up data in a prospective analysis. Inorganic arsenic, monomethylarsonate, and dimethylarsinate were measured in urine at baseline. CKD was defined as eGFR≤60 mL/min/1.73m2, kidney transplant or dialysis. Results CKD prevalence was 10.3%. The median (IQR) concentration of inorganic plus methylated arsenic species (total arsenic) in urine was 9.7 (5.8, 15.7) μg/L. The adjusted OR (95% CI) of prevalent CKD for an interquartile range in total arsenic was 0.7 (0.6, 0.8), mostly due to an inverse association with inorganic arsenic (OR 0.4 (0.3, 0.4)). Monomethylarsonate and dimethylarsinate were positively associated with prevalent CKD after adjustment for inorganic arsenic (OR 3.8 and 1.8). The adjusted HR of incident CKD for an IQR in ΣAs was 1.2 (1.03, 1.41). The corresponding HR for inorganic arsenic, monomethylarsonate and dimethylarsinate were 1.0 (0.9, 1.2), 1.2 (1.00, 1.3) and 1.2 (1.0, 1.4). Conclusions The inverse association of urine inorganic arsenic with prevalent CKD suggests that kidney disease affects excretion of inorganic arsenic. Arsenic species were positively associated with incident CKD. Studies with repeated measures are needed to further characterize the relationship between arsenic and kidney disease development.

show abstract

Estimated GFR and Incident Cardiovascular Disease Events in American Indians: The Strong Heart Study

Cited by 29 publications

References 30 publications

Pulmonary Hypertension Is Associated with Mortality and Cardiovascular Events in Chronic Kidney Disease Patients

Pulmonary Hypertension Is Associated with Mortality and Cardiovascular Events in Chronic Kidney Disease Patients

Chronic arsenic exposure and risk of carotid artery disease: The Strong Heart Study

The Association of Urine Arsenic with Prevalent and Incident Chronic Kidney Disease

Contact Info

Product

Resources

About