Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients: A 10-year follow-up study

Abstract

Chronic kidney disease (CKD) is highly prevalent among older post-myocardial infarction (MI) patients. It is not known whether CKD is an independent risk factor for mortality in older post-MI patients with optimal cardiovascular drug-treatment. Therefore, we studied the relation between kidney function and all-cause and specific mortality among older post-MI patients, without severe heart failure, who are treated with state-of-the-art pharmacotherapy. From 2002–2006, 4,561 Dutch post-MI patients were enrolled and followed until death or January 2012. We estimated Glomerular Filtration Rate (eGFR) with cystatin C (cysC) and creatinine (cr) using the CKD-EPI equations and analyzed the relation with any and major causes of death using Cox models and restricted cubic splines. Mean (SD) for age was 69 years (5.6), 79% were men, 17% smoked, 21% had diabetes, 90% used antihypertensive drugs, 98% used antithrombotic drugs and 85% used statins. Patients were divided into four categories of baseline eGFRcysC: ≥90 (33%; reference), 60–89 (47%), 30–59 (18%), and <30 (2%) ml/min/1.73m2. Median follow-up was 6.4 years. During follow-up, 873 (19%) patients died: 370 (42%) from cardiovascular causes, 309 (35%) from cancer, and 194 (22%) from other causes. After adjustment for age, sex and classic cardiovascular risk factor, hazard ratios (95%-confidence intervals) for any death according to the four eGFRcysC categories were: 1 (reference), 1.4 (1.1–1.7), 2.9 (2.3–3.6) and 4.4 (3.0–6.4). The hazard ratios of all-cause and cause-specific mortality increased linearly below kidney functions of 80 ml/min/1.73 m2. Weaker results were obtained for eGFRcr. To conclude, we found in optimal cardiovascular drug-treated post-MI patients an inverse graded relation between kidney function and mortality for both cardiovascular as well as non-cardiovascular causes. Risk of mortality increased linearly below kidney function of about 80 ml/min/1.73 m2.

Diet and Kidney Function: a Literature Review

“…If left untreated, CKD slowly progresses to endstage renal disease, which requires dialysis or kidney transplant [2,3]. CKD is bidirectionally associated with cardiovascular diseases (CVD) [4,5]. Hypertension [6] and type 2 diabetes mellitus (T2DM) [7,8] are independent risk factors for CKD [6,7], and their global prevalences are increasing [9,10], which will likely impact CKD.…”

Body-fat indicators and kidney function decline in older post-myocardial infarction patients: The Alpha Omega Cohort Study

“…In addition, we recently showed in the Alpha Omega Cohort Study a linear increase in mortality risk (cardiovascular and non-cardiovascular) for patients with an eGFR below 80 ml/min/1.73 m 2 . 4 Preservation of kidney function is therefore important, especially in these high-risk patients.…”

“…At baseline and after 41 months follow-up we measured from stored blood serum cystatin C (cysC) using a particle-enhanced immunonephelometric assay and serum creatinine (cr) by the modified kinetic Jaffé method, as previously described in detail. 4 We estimated glomerular filtration rate (eGFR) with cysC alone and the combined cr-cysC Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations from 2012, taking into account age, sex and race. 13 In the main analyses, results are shown for eGFR cysC , as it is recommended for confirmatory testing in the current Kidney Disease - Improving Global Outcomes (KDIGO) guidelines.…”

“…1 – 3 Impaired kidney function itself is a robust and independent risk factor for cardiovascular morbidity and mortality. 4 The annual rate of kidney function decline in post-myocardial infarction (post-MI) patients is more than double that of the general population. 5 , 6 …”

Typ-2-Diabetes im Alter

“…Mit den Zusammenhängen zwischen Nierenfunktion und Sterblichkeit befasste sich kürzlich eine prospektive Kohortenstudie: Untersucht wurden 4561 Patienten im Alter von 60-80 Jahren, die einen Myokardinfakt erlitten hatten, aber keine Herzinsuffizienz aufwiesen und eine Pharmakotherapie nach "State of the art" erhielten [11]. Nach Adjustierung für Alter, Geschlecht und klassischen Risikofaktoren inkl.…”