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Epidemiology and Outcomes
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Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies

Daniel E. Weiner, Hocine Tighiouart, Manish G. Amin, Paul C. Stark, Bonnie MacLeod, John L. Griffith, Deeb N. Salem, Andrew S. Levey and Mark J. Sarnak
JASN May 2004, 15 (5) 1307-1315; DOI: https://doi.org/10.1097/01.ASN.0000123691.46138.E2
Daniel E. Weiner
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Hocine Tighiouart
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Manish G. Amin
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Paul C. Stark
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Bonnie MacLeod
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John L. Griffith
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Deeb N. Salem
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Andrew S. Levey
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Mark J. Sarnak
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    Figure 1. Kaplan-Meier survival analysis for the composite outcome stratified by the presence of chronic kidney disease. Bars represent 95% confidence intervals.

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    Figure 2. Racial differences in the adjusted 10-yr probability of survival to the composite outcome based on level of GFR. Dashed lines represent 95% confidence intervals.

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  • Table 1. Baseline characteristics by original study and CKD groupa

    Baseline VariablesARIC (n = 12,904)CHS (n = 4,232)FHS (n = 1,950)Offspring (n = 3,548)CKDb (n = 1,664)No CKDb (n = 20,970)Total (n = 22,634)
    a CKD, chronic kidney disease; ARIC, Atherosclerosis Risk in Communities Study; CHS, Cardiovascular Health Study; FHS, Framingham Heart Study; Offspring, Framingham Offspring Study; BMI, body mass index; LVH, left ventricular hypertrophy.
    b The P value for all variables between subjects with CKD and those without CKD is <0.05 with the exception of LVH and HDL cholesterol.
    All values for continuous variables are means ± SD.
    Demographic data (%)
        age (yr)53.9 ± 5.772.9 ± 5.468.1 ± 7.243.9 ± 10.068.1 ± 11.456.2 ± 11.257.1 ± 11.6
        male44.538.837.648.333.144.243.4
        black27.514.5009.619.118.4
        high school graduate77.972.465.592.770.178.878.2
    Lifestyle (%)
        smoking, current25.612.425.836.215.725.524.8
        alcohol, current57.451.461.676.752.360.259.7
    Medical history (%)
        diabetes9.513.710.93.813.99.29.5
        hypertension36.159.952.421.962.138.039.7
    Medication use (%)
        antihypertensive agents26.638.827.98.945.924.726.2
        lipid-lowering agents2.44.32.00.63.42.32.4
        diabetes agents4.56.74.31.07.14.14.3
    Physical characteristics
        BMI (kg/m2)27.5 ± 5.226.5 ± 4.126.2 ± 4.127.7 ± 4.626.9 ± 4.527.3 ± 4.927.2 ± 4.9
        systolic BP (mmHg)121.1 ± 18.6136.3 ± 21.4135.6 ± 18.6122.0 ± 16.3134.7 ± 22.1124.6 ± 19.6125.3 ± 20.0
        diastolic BP (mmHg)73.9 ± 11.271.3 ± 11.575.9 ± 9.878.0 ± 9.773.6 ± 11.574.3 ± 11.174.3 ± 11.1
        LVH (%)4.83.41.20.33.43.53.5
    Laboratory values
        creatinine calibrated (mg/dl)0.9 ± 0.20.9 ± 0.30.9 ± 0.30.8 ± 0.21.3 ± 0.30.8 ± 0.20.9 ± 0.2
        GFR (ml/min per 1.73 m2)93.3 ± 19.879.9 ± 22.083.2 ± 28.398.7 ± 28.351.7 ± 7.693.9 ± 21.490.8 ± 23.4
        total cholesterol (mg/dl)214 ± 42212 ± 39230 ± 41233 ± 47224 ± 46218 ± 43218 ± 43
        HDL cholesterol (mg/dl)52 ± 1756 ± 1651 ± 1549 ± 1352 ± 1652 ± 1652 ± 16
  • Table 2. Baseline characteristics and outcomes by race and level of kidney functiona

    Baseline VariablesGFR Group (ml/min per 1.73 m2)
    WhiteBlack
    15–59 (n = 1,505)≥60 (n = 16,961)15–59 (n = 159)≥60 (n = 4,009)
    a MI, myocardial infarction; CHD, coronary heart disease.
    All values for continuous variables are means ± SD and for categorical variables are percentages.
    Demographic data (%)
        age (yr)68.2 ± 11.356.3 ± 11.766.7 ± 11.955.8 ± 8.6
        male33.045.533.338.8
        high school graduate71.883.354.159.7
    Lifestyle (%)
        smoking, current15.024.922.628.0
        alcohol, current55.366.423.934.0
    Medical history (%)
        diabetes12.47.428.316.7
        hypertension59.433.488.157.2
    Medication use (%)
        antihypertensive agents42.320.779.241.4
        lipid-lowering agents3.42.53.71.4
        diabetes agents5.52.822.210.0
    Physical characteristics
        BMI (kg/m2)26.7 ± 4.326.8 ± 4.529.2 ± 5.729.2 ± 5.9
        systolic BP (mmHg)133.9 ± 21.6123.3 ± 18.9143.0 ± 25.6129.3 ± 20.9
        diastolic BP (mmHg)73.0 ± 11.273.1 ± 10.579.4 ± 12.579.4 ± 11.9
        LVH (%)2.62.011.99.2
    Laboratory values
        creatinine calibrated (mg/dl)1.3 ± 0.30.8 ± 0.21.6 ± 0.50.9 ± 0.2
        GFR (ml/min per 1.73 m2)51.9 ± 7.391.9 ± 20.949.6 ± 10.0102.0 ± 21.5
        total cholesterol (mg/dl)225 ± 45219 ± 42216 ± 47214 ± 44
        HDL cholesterol (mg/dl)52 ± 1652 ± 1654 ± 1856 ± 17
    Clinical outcomes (%)
        MI/fatal CHD9.75.513.84.6
        stroke7.32.69.43.7
        all-cause mortality22.57.927.78.7
  • Table 3. Outcomes by level of kidney function

    GFR15–59 (ml/min per 1.73 m2)GFR≥60 (ml/min per 1.73 m2)
    a Note that because events may overlap categories, the sum of events is greater than the composite total.
    MI/fatal CHD
        % events10.1% (168/1664)5.3% (1111/20970)
        person-years at risk12,125169,779
        events per 1000  person-years13.96.5
    Stroke
        % events7.5% (125/1664)2.8% (587/20970)
        person-years at risk12,168171,470
        events per 1000  person-years10.33.4
    All-cause mortality
        % events23.0% (383/1664)8.1% (1693/20970)
        person-years at risk12,450172,926
        events per 1000  person-years30.89.8
    Compositea
        % events30.1% (500/1664)13.2% (2762/20970)
        person-years at risk11,887168,459
        events per 1000  person-years42.116.4
  • Table 4. Hazard ratio for outcomes in patients with CKD in the fully adjusted modela

    OutcomeHazard Ratio (95% CI)P ValueP Value for Race Interaction
    a Covariates include age, gender, history of hypertension, history of diabetes, systolic BP, BMI, total and HDL cholesterol, current smoking, current alcohol use, LVH, high school graduation status, and race where applicable.
    MI/FCHD
        all1.09 (0.91 to 1.29)0.350.003
        white1.01 (0.84 to 1.21)0.94
        black2.09 (1.33 to 3.26)0.001
    Stroke
        all1.17 (0.95 to 1.44)0.130.90
        white1.17 (0.94 to 1.45)0.17
        black1.21 (0.71 to 2.08)0.48
    MI/FCHD/stroke
        all1.10 (0.95 to 1.26)0.200.004
        white1.03 (0.89 to 1.19)0.70
        black1.78 (1.25 to 2.54)0.001
    All-cause mortality
        all1.36 (1.21 to 1.53)<0.0010.053
        white1.31 (1.16 to 1.49)<0.001
        black1.83 (1.33 to 2.52)<0.001
    Composite
        all1.19 (1.07 to 1.32)0.0010.002
        white1.13 (1.02 to 1.26)0.02
        black1.76 (1.35 to 2.31)<0.001
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Journal of the American Society of Nephrology: 15 (5)
Journal of the American Society of Nephrology
Vol. 15, Issue 5
1 May 2004
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Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies
Daniel E. Weiner, Hocine Tighiouart, Manish G. Amin, Paul C. Stark, Bonnie MacLeod, John L. Griffith, Deeb N. Salem, Andrew S. Levey, Mark J. Sarnak
JASN May 2004, 15 (5) 1307-1315; DOI: 10.1097/01.ASN.0000123691.46138.E2

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Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies
Daniel E. Weiner, Hocine Tighiouart, Manish G. Amin, Paul C. Stark, Bonnie MacLeod, John L. Griffith, Deeb N. Salem, Andrew S. Levey, Mark J. Sarnak
JASN May 2004, 15 (5) 1307-1315; DOI: 10.1097/01.ASN.0000123691.46138.E2
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