Renal Function and Heart Failure Risk in Older Black and White Individuals

Bibbins‐Domingo, Kirsten; Chertow, Glenn M.; Fried, Linda F.; Odden, Michelle C.; Newman, Anne B.; Kritchevsky, Stephen B.; Harris, Tamara B.; Satterfield, Suzanne; Cummings, Steven R.; Shlipak, Michael G.

doi:10.1001/archinte.166.13.1396

Cited by 57 publications

(42 citation statements)

References 36 publications

(38 reference statements)

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“…This association was independent of obesity, baseline glucose, eGFR (or serum creatinine), ACR, and other explanatory variables. These results extend previous observations for CVD (17,18,20,32,33) to include the early diabetic stage.…”

Section: Results -supporting

confidence: 90%

“…Currently used estimating equations are poor at identifying early renal impairment and better indexes are of great interest (15,16). Recently, several studies have suggested that cystatin C levels may be a more sensitive marker of early renal impairment than either albuminuria or serum creatinine concentration (17)(18)(19)(20). Cystatin C is a novel measure of kidney function that seems to overcome the limitations of serum creatinine concentration.…”

mentioning

confidence: 99%

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Elevated Cystatin C Concentration and Progression to Pre-Diabetes

et al. 2007

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OBJECTIVE -We conducted a nested case-control investigation to examine whether elevated baseline concentrations of cystatin C predicted progression from normoglycemia to prediabetes over 6 years of follow-up from the Western New York Health Study. participants from the Western New York Health Study, who were free of type 2 diabetes and known cardiovascular disease at baseline (1996 -2001), were reexamined. An incident case of pre-diabetes was defined as an individual with fasting glucose Ͻ100 mg/dl at the baseline examination and Ն100 and Յ125 mg/dl at the follow-up examination, thereby eliminating individuals with prevalent prediabetics. All case patients (n ϭ 91) were matched 1:3 to control participants based on sex, race/ethnicity, and year of study enrollment. All control subjects had fasting glucose levels Ͻ100 mg/dl at both baseline and follow-up examinations. Cystatin C concentrations and the urinary albumin-to-creatinine ratio were measured from frozen (Ϫ196°C) baseline blood and urine samples. Serum creatinine concentrations were available from the baseline examination only. RESEARCH DESIGN AND METHODSRESULTS -Multivariate conditional logistic regression analyses adjusted for age, baseline glucose level, homeostasis model assessment of insulin resistance, BMI, hypertension, estimated glomerular filtration rate, cigarette smoking, and alcohol use revealed a significantly increased risk of progression to pre-diabetes among those with elevated baseline concentrations of cystatin C (odds ratio 3.28 [95% CI 1.43-7.54]) (upper quintile versus the remainder). Results of secondary analyses that considered high-sensitivity C-reactive protein, interleukin-6, E-selectin, or soluble intercellular adhesion molecule-1 did not alter these results.CONCLUSIONS -These results suggest that cystatin C was associated with a threefold excess risk of progression to pre-diabetes in this population. Diabetes Care 30:1724-1729, 2007R ecent evidence from randomized clinical trials (1,2) among people with pre-diabetes have provided convincing evidence that early intervention can significantly delay or prevent the progression to type 2 diabetes. The identification of those with pre-diabetes is assuming greater importance (3), especially in light of the fact that ϳ37% of adults aged 40 -74 years in the U.S. have prediabetes defined as impaired fasting glucose (4). Microalbuminuria occurs frequently in nondiabetic subjects and places them at increased risk for cardiovascular disease (CVD) (5-7). The mechanisms behind this observation are poorly understood, however. Albuminuria may reflect underlying vascular damage (8), hypertension (9,10), endothelial dysfunction (11,12), and/or low-grade inflammation (13).A large percentage of individuals with type 2 diabetes pass through a period of pre-diabetes (14) and may experience early renal dysfunction, e.g., a glomerular filtration rate (GFR) Ͼ60 ml/min per 1.73 m 2 . Currently used estimating equations are poor at identifying early renal impairment and better indexes are of great interes...

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Section: Results -supporting

confidence: 90%

mentioning

confidence: 99%

Elevated Cystatin C Concentration and Progression to Pre-Diabetes

et al. 2007

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“…Consistent with these findings, CKD has been reported to result in a significantly greater increase in risk for coronary artery disease mortality or incident congestive heart failure among blacks than white individuals. 18,19 In our study, death was the only outcome measure studied, and we were unable to demonstrate any interaction between race and CKD.…”

Section: Discussionmentioning

confidence: 57%

Racial Differences in Mortality Among Those with CKD

Mehrotra

Kermah

Fried³

et al. 2008

Journal of the American Society of Nephrology

123

113

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Compared with white individuals, black individuals have a significantly higher risk for death in the general population but seem to have a survival advantage in the ESRD population. Data on the relationship of race to survival in early stages of chronic kidney disease (CKD) are inconsistent. This study evaluated racial differences in mortality among the adult participants of the Third National Health and Nutrition Examination Survey, a population-based survey of community-dwelling individuals. CKD was defined either by an estimated GFR Ͻ60 ml/min per 1.73 m 2 or by the presence of albuminuria, and this status was determined for 14,611 individuals, 2892 of whom were found to have CKD. Adjusting for age, gender, and race, risk for all-cause mortality among individuals with CKD was more than double that of individuals with normal renal function. In the subgroup with CKD, adjusting for age and gender, black individuals had a significantly higher risk for death, and this risk was modified by age; specifically, black individuals who were younger than 65 yr were 78% more likely to die than white individuals, whereas no significant differences in mortality were observed among individuals who were Ն65 yr of age. Further adjustment for cardiovascular risk factors and CKD stage did not materially change the results, but the hazard ratios were significantly attenuated after adjustment for socioeconomic factors. In conclusion, these data demonstrate racial/ethnic disparities in mortality among individuals with CKD. This higher risk for death in early stages of CKD may explain the apparent survival advantage observed among black individuals who live long enough to reach stage 5 CKD. 19: 140319: -141019: , 200819: . doi: 10.1681 In the general population, the cardiovascular and noncardiovascular mortality rates for black individuals are persistently higher than those for white individuals. [1][2][3] In contrast, studies among individuals who have stage 5 chronic kidney disease (CKD) and are undergoing maintenance dialysis have consistently shown that black individuals have a survival advantage compared with white individuals. 4,5 Even though some studies in the general population have shown lower mortality rates among Mexican Americans despite a higher prevalence of cardiovascular risk factors and lower socioeconomic status ("Hispanic paradox"), studies with more complete follow-up demonstrated poorer outcomes in this ethnic group when compared with non-Hispanic white individuals. 2,6,7 In contrast, Hispanic individuals with stage 5 CKD also seem to have a survival advantage. 5,8 Despite various hypotheses, these paradoxic disparities with survival advantages for racial/ethnic minorities undergoing maintenance dialysis have not been satisfactorily explained. J Am Soc Nephrol

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“…2,18,19 Thus, efforts to increase detection and recognition of decreased GFR have been the focus of national and international campaigns. In these analyses, we found that the presence of eGFR Ͻ60 ml/ min per 1.73 m 2 was only associated with elevated risk of death, cardiovascular events, and heart failure if it was confirmed by cystatin C. Persons with decreased GFR by creatinine alone had equivalent risks to persons without decreased GFR.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C Identifies Chronic Kidney Disease Patients at Higher Risk for Complications

Peralta

Katz

Sarnak

et al. 2011

Journal of the American Society of Nephrology

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204

163

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Although cystatin C is a stronger predictor of clinical outcomes associated with CKD than creatinine, the clinical role for cystatin C is unclear. We included 11,909 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS) and assessed risks for death, cardiovascular events, heart failure, and ESRD among persons categorized into mutually exclusive groups on the basis of the biomarkers that supported a diagnosis of CKD (eGFR Ͻ60 ml/min per 1.73 m 2 ): creatinine only, cystatin C only, both, or neither. We used CKD-EPI equations to estimate GFR from these biomarkers. In MESA, 9% had CKD by the creatinine-based equation only, 2% had CKD by the cystatin C-based equation only, and 4% had CKD by both equations; in CHS, these percentages were 12, 4, and 13%, respectively. Compared with those without CKD, the adjusted hazard ratios (HR) for mortality in MESA were: 0.80 (95% CI 0.50 to 1.26) for CKD by creatinine only; 3.23 (95% CI 1.84 to 5.67) for CKD by cystatin C only; and 1.93 (95% CI 1.27 to 2.92) for CKD by both; in CHS, the adjusted HR were 1.09 (95% CI 0.98 to 1.21), 1.78 (95% CI 1.53 to 2.08), and 1.74 (95% CI 1.58 to 1.93), respectively. The pattern was similar for cardiovascular disease (CVD), heart failure, and kidney failure outcomes. In conclusion, among adults diagnosed with CKD using the creatinine-based CKD-EPI equation, the adverse prognosis is limited to the subset who also have CKD according to the cystatin C-based equation. Cystatin C may have a role in identifying persons with CKD who have the highest risk for complications.

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Renal Function and Heart Failure Risk in Older Black and White Individuals

Abstract: The association of kidney dysfunction with heart failure appears stronger in blacks than for whites, particularly when cystatin C is used to measure kidney function.

Cited by 57 publications

References 36 publications

Elevated Cystatin C Concentration and Progression to Pre-Diabetes

Elevated Cystatin C Concentration and Progression to Pre-Diabetes

Racial Differences in Mortality Among Those with CKD

Cystatin C Identifies Chronic Kidney Disease Patients at Higher Risk for Complications

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