Abstract: SA-PO781
Association of eGFR and ACR with Cardiovascular Outcomes in the Elderly
Session Information
- CKD: Epidemiology, Risk Factors, Prevention - III
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Kuehn, Andreas, Charite - Universitaetsmedizin Berlin, Berlin, Germany
- Ebert, Natalie, Charite - Universitaetsmedizin Berlin, Berlin, Germany
- Gaedeke, Jens, Dept. of Nephrology, Charité, Berlin, Germany
- van der Giet, Markus, Charite - Universitaetsmedizin Berlin, Berlin, Germany
- Kuhlmann, Martin K., Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Mielke, Nina, Charite - Universitaetsmedizin Berlin, Berlin, Germany
- Schaeffner, Elke, Charite - Universitaetsmedizin Berlin, Berlin, Germany
Background
Data on the effect of kidney function (eGFR) / kidney damage (ACR) on cardiovascular (CV) outcomes in the elderly remain scarce. We investigated the effect of eGFR on cardiovascular outcomes using data of the Berlin Initiative Study (BIS).
Methods
The BIS has followed 2069 older adults ≥70 yrs since 2009. eGFR/kidney damage were assessed by eGFR-BIS2(crea/cysC) and ACR, respectively. ICD-10-based outcomes were stroke or myocardial infarction (MI), combined or single, ischemic stroke, and death to all-cause. A Competing Risk Model was set up for CV events, a Cox proportional hazards model for all-cause mortality for hazard ratios(HR) and 95% confidence intervals (CI). Individuals with CV event before baseline were excluded. Models adjusted for age, sex, diabetes, smoking, waist-to-hip-ratio, antihypert. treatment, systolic BP, pulse pressure, c-reactive protein, total and high density cholesterol.
Results
Within a median f/up of 7.1 yrs, 276 CV events and 680 deaths occured. For eGFR<60mL/min/1.73m2 highest HRs were seen for (ischemic) stroke (Table 2). Highest HR of 2.11 (1.36-3.29) was observed for ischemic stroke if eGFR was 45-59mL/min/1.73m2.
HRs were highest for the combination of eGFR <60mL/min/1.73m2 and ACR >30mg/g for all outcomes. For stroke, isolated reduced eGFR revealed a similar HR of 1.85 (1.19-2.90) as reduced eGFR and increased ACR combined. For death, isolated increased ACR had a HR of 2.04 (1.43-2.90).
Conclusion
After adjusting, reduced eGFR was highly associated with hazard of stroke in older adults. As for the combination of eGFR and ACR, the distribution of HRs for the cardiovascular outcomes suggests an association of ischemic stroke risk only with eGFR and a strong independent association of ACR with all-cause mortality.
Baseline characteristics
| Group by eGFR (BIS2) | All individuals | eGFR ≥ 60mL/min/1.73m2 | eGFR < 60mL/min/1.73m2 |
| Individuals (% of total) Age (mean±SD*), years Female (%) | 2069 (100.0) 80.4 ± 6.7 1088 (52.6) | 810 (39.2) 76.5 ± 5.0 419 (51.7) | 1257 (60.8) 82.9 ± 6.4 668 (53.1) |
| Prior stroke (%) Prior myocardial infarction (MI) (%) Prior stroke or MI (%) | 201 (9.7) 309 (14.9) 460 (22.3) | 51 (6.3) 85 (10.5) 126 (15.6) | 150 (11.9) 224 (17.8) 334 (26.6) |
| Diabetes mellitus (%) Systolic blood pressure (mean±SD*), mmHg Pulse pressure (mean±SD*), mmHg | 541 (26.2) 145.7 ± 21.8 64.2 ± 18.7 | 192 (23.7) 146.8 ± 21.0 62.9 ± 17.8 | 349 (27.8) 145.0 ± 22.3 65.0 ± 19.2 |
| ACR (%) ≤ 30 mg/g > 30-300 mg/g > 300 mg/g missing | 1523 (74.1) 458 (22.3) 74 (3.6) 14 (0.7) | 663 (82.0) 137 (16.9) 9 (1.1) 1 (0.1) | 858 (69.0) 321 (25.8) 65 (5.2) 13 (1.0) |
Funding
- Private Foundation Support