Kidney Function as a Predictor of Noncardiovascular Mortality

Abstract

Chronic kidney disease is associated with a higher risk for cardiovascular mortality, as well as all-cause mortality. Whether chronic kidney disease is a predictor of noncardiovascular mortality is less clear. To further explore the latter, the association of kidney function with total noncardiovascular mortality and cause-specific mortality was assessed in the Cardiovascular Health Study, a community-based cohort of older individuals. Kidney disease was assessed using cystatin C and estimated GFR in 4637 participants in 1992 to 1993. Participants were followed until June 30, 2001. Deaths were adjudicated as cardiovascular or noncardiovascular disease by committee, and an underlying cause of death was assigned. The associations of kidney function with total noncardiovascular mortality and cause-specific mortality were analyzed by proportional hazards regression. Noncardiovascular mortality rates increased with higher cystatin C quartiles (16.8, 17.1, 21.6, and 50.0 per 1000 person-years). The association of cystatin C with noncardiovascular mortality persisted after adjustment for demographic factors; the presence of diabetes, C-reactive protein, hemoglobin, and prevalent cardiovascular disease; and measures of atherosclerosis (hazard ratio 1.69; 95% confidence interval 1.33 to 2.15, for the fourth quartile versus the first quartile). Results for estimated GFR were similar. The risk for noncardiac deaths attributed to pulmonary disease, infection, cancer, and other causes was similarly associated with cystatin C levels. Kidney function predicts noncardiovascular mortality from multiple causes in the elderly. Further research is needed to understand the mechanisms and evaluate interventions to reduce the high mortality rate in chronic kidney disease.

Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study

“…Patients with only one postoperative GFR estimation (49 partial nephrectomy, 27 radical nephrectomy) were censored at the time of that GFR estimation. 3-year and 5-year probabilities of freedom from new onset of GFR lower than 60 mL/min per 1·73 m 2 were 80% (95% CI 73-85) and 67% (57-75), respectively, for patients who underwent partial nephrectomy, compared with corresponding values of 35% (28-43) and 23% (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) for those who underwent radical nephrectomy (p<0·0001; figure 2). Median time to development of GFR lower than 60 mL/min per 1·73 m 2 was 18 months (IQR 10-55) for the radical nephrectomy group and was not reached for the partial nephrectomy group.…”

“…Since the cancer-specific survival for patients with small, renal cortical tumours is greater than 90% across all histological subtypes, 4,41 these patients are susceptible to developing long-term sequelae from their treatment. Several studies [16][17][18] have shown an independent and graded association between decreased estimated GFR and substantial comorbidity, increased admissions, and increased cardiac-related and non-cardiacrelated deaths. Patients undergoing radical nephrectomy have a greater than 35% chance of developing a GFR lower than 45 mL/min per 1·73 m 2 within 3 years of surgery, theoretically placing them at risk for these complications.…”

“…15 The major outcomes of chronic kidney disease are: loss of kidney function, sometimes leading to kidney failure; complications of reduced kidney function, such as hypertension, anaemia, malnutrition, neuropathy, and reduced quality of life; and increased risk of cardiovascular disease and mortality. [16][17][18] Because of raised awareness of important health risks associated with chronic kidney disease, 15-19 and worldwide data [8][9][10] showing the probable overuse of radical nephrectomy, we aimed to review our nephrectomy database and assess kidney function outcomes in patients undergoing surgery for small, solitary, renal cortical tumours.…”

The Relationship Between Nontraditional Risk Factors and Outcomes in Individuals With Stage 3 to 4 CKD

“…Additionally, this study examined only CVD death as an outcome; however, individuals with CKD are at high risk of all-cause mortality and this competing risk my obscure statistically significant risk factors. 21,22 An examination of the ARIC cohort by Muntner et al evaluated 391 individuals with CKD at baseline, and, in order to increase power, analyzed an additional 416 individuals who had developed CKD at the time of their second evaluation. 7 In multivariable analyses, increased waist circumference, apolipoprotein B, fibrinogen, anemia, and reduced albumin were all associated with cardiac events.…”

Kidney Function and Prevalent and Incident Frailty

“…Although CKD is known to affect cardiovascular disease risk, in older adults it has also been associated with noncardiovascular complications, poor physical functioning, and unsuccessful aging (2)(3)(4)(5). Of interest is whether kidney function is independently associated with frailty, defined as a lack of physiologic reserve.…”