Relationship between stage of kidney disease and incident heart failure in older adults

C. Barrett Bowling, Margaret A. Feller, Marjan Mujib, Pushkar P. Pawar, Yan Zhang, O. James Ekundayo, Inmaculada B. Aban, Thomas E. Love, Paul W. Sanders, Stefan D. Anker, Gregg C. Fonarow, Ali Ahmed

Research output: Contribution to journalArticle

Abstract

Background: The relationship between stage of chronic kidney disease (CKD) and incident heart failure (HF) remains unclear. Methods: Of the 5,795 community-dwelling adults ≥65 years in the Cardiovascular Health Study, 5,450 were free of prevalent HF and had baseline estimated glomerular filtration rate (eGFR: ml/min/1.73 m 2) data. Of these, 898 (16%) had CKD 3A (eGFR 45-59 ml/min/1.73 m 2) and 242 (4%) had CKD stage ≥3B (eGFR 2). Data on baseline proteinuria were not available and 4,310 (79%) individuals with eGFR ≥60 ml/min/1.73 m 2 were considered to have no CKD. Propensity scores estimated separately for CKD 3A and ≥3B were used to assemble two cohorts of 1,714 (857 pairs with CKD 3A and no CKD) and 557 participants (148 CKD ≥3B and 409 no CKD), respectively, balanced on 50 baseline characteristics. Results: During 13 years of follow-up, centrally-adjudicated incident HF occurred in 19, 24 and 38% of pre-match participants without CKD (reference), with CKD 3A [unadjusted hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.20-1.63; p <0.001] and with CKD ≥3B (HR 3.37; 95% CI 2.71-4.18; p <0.001), respectively. In contrast, among matched participants, incident HF occurred in 23 and 23% of those with CKD 3A and no CKD, respectively (HR 1.03; 95% CI 0.85-1.26; p = 0.746), and 36 and 28% of those with CKD ≥3B and no CKD, respectively (HR 1.44; 95% CI 1.04-2.00; p = 0.027). Conclusions: Among community-dwelling older adults, CKD is a marker of incident HF regardless of stage; however, CKD ≥3B, not CKD 3A, has a modest independent association with incident HF.

Original languageEnglish
Pages (from-to)135-141
Number of pages7
JournalAmerican Journal of Nephrology
Volume34
Issue number2
DOIs
Publication statusPublished - Aug 2011

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Kidney Diseases
Chronic Renal Insufficiency
Heart Failure
Confidence Intervals
Independent Living
Propensity Score

Keywords

  • Chronic kidney disease
  • Heart failure

ASJC Scopus subject areas

  • Nephrology

Cite this

Bowling, C. B., Feller, M. A., Mujib, M., Pawar, P. P., Zhang, Y., Ekundayo, O. J., ... Ahmed, A. (2011). Relationship between stage of kidney disease and incident heart failure in older adults. American Journal of Nephrology, 34(2), 135-141. https://doi.org/10.1159/000328905

Relationship between stage of kidney disease and incident heart failure in older adults. / Bowling, C. Barrett; Feller, Margaret A.; Mujib, Marjan; Pawar, Pushkar P.; Zhang, Yan; Ekundayo, O. James; Aban, Inmaculada B.; Love, Thomas E.; Sanders, Paul W.; Anker, Stefan D.; Fonarow, Gregg C.; Ahmed, Ali.

In: American Journal of Nephrology, Vol. 34, No. 2, 08.2011, p. 135-141.

Research output: Contribution to journalArticle

Bowling, CB, Feller, MA, Mujib, M, Pawar, PP, Zhang, Y, Ekundayo, OJ, Aban, IB, Love, TE, Sanders, PW, Anker, SD, Fonarow, GC & Ahmed, A 2011, 'Relationship between stage of kidney disease and incident heart failure in older adults', American Journal of Nephrology, vol. 34, no. 2, pp. 135-141. https://doi.org/10.1159/000328905
Bowling, C. Barrett ; Feller, Margaret A. ; Mujib, Marjan ; Pawar, Pushkar P. ; Zhang, Yan ; Ekundayo, O. James ; Aban, Inmaculada B. ; Love, Thomas E. ; Sanders, Paul W. ; Anker, Stefan D. ; Fonarow, Gregg C. ; Ahmed, Ali. / Relationship between stage of kidney disease and incident heart failure in older adults. In: American Journal of Nephrology. 2011 ; Vol. 34, No. 2. pp. 135-141.
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abstract = "Background: The relationship between stage of chronic kidney disease (CKD) and incident heart failure (HF) remains unclear. Methods: Of the 5,795 community-dwelling adults ≥65 years in the Cardiovascular Health Study, 5,450 were free of prevalent HF and had baseline estimated glomerular filtration rate (eGFR: ml/min/1.73 m 2) data. Of these, 898 (16{\%}) had CKD 3A (eGFR 45-59 ml/min/1.73 m 2) and 242 (4{\%}) had CKD stage ≥3B (eGFR 2). Data on baseline proteinuria were not available and 4,310 (79{\%}) individuals with eGFR ≥60 ml/min/1.73 m 2 were considered to have no CKD. Propensity scores estimated separately for CKD 3A and ≥3B were used to assemble two cohorts of 1,714 (857 pairs with CKD 3A and no CKD) and 557 participants (148 CKD ≥3B and 409 no CKD), respectively, balanced on 50 baseline characteristics. Results: During 13 years of follow-up, centrally-adjudicated incident HF occurred in 19, 24 and 38{\%} of pre-match participants without CKD (reference), with CKD 3A [unadjusted hazard ratio (HR) 1.40; 95{\%} confidence interval (CI) 1.20-1.63; p <0.001] and with CKD ≥3B (HR 3.37; 95{\%} CI 2.71-4.18; p <0.001), respectively. In contrast, among matched participants, incident HF occurred in 23 and 23{\%} of those with CKD 3A and no CKD, respectively (HR 1.03; 95{\%} CI 0.85-1.26; p = 0.746), and 36 and 28{\%} of those with CKD ≥3B and no CKD, respectively (HR 1.44; 95{\%} CI 1.04-2.00; p = 0.027). Conclusions: Among community-dwelling older adults, CKD is a marker of incident HF regardless of stage; however, CKD ≥3B, not CKD 3A, has a modest independent association with incident HF.",
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AU - Feller, Margaret A.

AU - Mujib, Marjan

AU - Pawar, Pushkar P.

AU - Zhang, Yan

AU - Ekundayo, O. James

AU - Aban, Inmaculada B.

AU - Love, Thomas E.

AU - Sanders, Paul W.

AU - Anker, Stefan D.

AU - Fonarow, Gregg C.

AU - Ahmed, Ali

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N2 - Background: The relationship between stage of chronic kidney disease (CKD) and incident heart failure (HF) remains unclear. Methods: Of the 5,795 community-dwelling adults ≥65 years in the Cardiovascular Health Study, 5,450 were free of prevalent HF and had baseline estimated glomerular filtration rate (eGFR: ml/min/1.73 m 2) data. Of these, 898 (16%) had CKD 3A (eGFR 45-59 ml/min/1.73 m 2) and 242 (4%) had CKD stage ≥3B (eGFR 2). Data on baseline proteinuria were not available and 4,310 (79%) individuals with eGFR ≥60 ml/min/1.73 m 2 were considered to have no CKD. Propensity scores estimated separately for CKD 3A and ≥3B were used to assemble two cohorts of 1,714 (857 pairs with CKD 3A and no CKD) and 557 participants (148 CKD ≥3B and 409 no CKD), respectively, balanced on 50 baseline characteristics. Results: During 13 years of follow-up, centrally-adjudicated incident HF occurred in 19, 24 and 38% of pre-match participants without CKD (reference), with CKD 3A [unadjusted hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.20-1.63; p <0.001] and with CKD ≥3B (HR 3.37; 95% CI 2.71-4.18; p <0.001), respectively. In contrast, among matched participants, incident HF occurred in 23 and 23% of those with CKD 3A and no CKD, respectively (HR 1.03; 95% CI 0.85-1.26; p = 0.746), and 36 and 28% of those with CKD ≥3B and no CKD, respectively (HR 1.44; 95% CI 1.04-2.00; p = 0.027). Conclusions: Among community-dwelling older adults, CKD is a marker of incident HF regardless of stage; however, CKD ≥3B, not CKD 3A, has a modest independent association with incident HF.

AB - Background: The relationship between stage of chronic kidney disease (CKD) and incident heart failure (HF) remains unclear. Methods: Of the 5,795 community-dwelling adults ≥65 years in the Cardiovascular Health Study, 5,450 were free of prevalent HF and had baseline estimated glomerular filtration rate (eGFR: ml/min/1.73 m 2) data. Of these, 898 (16%) had CKD 3A (eGFR 45-59 ml/min/1.73 m 2) and 242 (4%) had CKD stage ≥3B (eGFR 2). Data on baseline proteinuria were not available and 4,310 (79%) individuals with eGFR ≥60 ml/min/1.73 m 2 were considered to have no CKD. Propensity scores estimated separately for CKD 3A and ≥3B were used to assemble two cohorts of 1,714 (857 pairs with CKD 3A and no CKD) and 557 participants (148 CKD ≥3B and 409 no CKD), respectively, balanced on 50 baseline characteristics. Results: During 13 years of follow-up, centrally-adjudicated incident HF occurred in 19, 24 and 38% of pre-match participants without CKD (reference), with CKD 3A [unadjusted hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.20-1.63; p <0.001] and with CKD ≥3B (HR 3.37; 95% CI 2.71-4.18; p <0.001), respectively. In contrast, among matched participants, incident HF occurred in 23 and 23% of those with CKD 3A and no CKD, respectively (HR 1.03; 95% CI 0.85-1.26; p = 0.746), and 36 and 28% of those with CKD ≥3B and no CKD, respectively (HR 1.44; 95% CI 1.04-2.00; p = 0.027). Conclusions: Among community-dwelling older adults, CKD is a marker of incident HF regardless of stage; however, CKD ≥3B, not CKD 3A, has a modest independent association with incident HF.

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