Article Figures & Data
Figures
Figure 1. Kaplan-Meier survival analysis for the composite outcome stratified by the presence of chronic kidney disease. Bars represent 95% confidence intervals.
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.
Tables
Table 1. Baseline characteristics by original study and CKD groupa
Baseline Variables ARIC (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 ± 5.7 72.9 ± 5.4 68.1 ± 7.2 43.9 ± 10.0 68.1 ± 11.4 56.2 ± 11.2 57.1 ± 11.6 male 44.5 38.8 37.6 48.3 33.1 44.2 43.4 black 27.5 14.5 0 0 9.6 19.1 18.4 high school graduate 77.9 72.4 65.5 92.7 70.1 78.8 78.2 Lifestyle (%) smoking, current 25.6 12.4 25.8 36.2 15.7 25.5 24.8 alcohol, current 57.4 51.4 61.6 76.7 52.3 60.2 59.7 Medical history (%) diabetes 9.5 13.7 10.9 3.8 13.9 9.2 9.5 hypertension 36.1 59.9 52.4 21.9 62.1 38.0 39.7 Medication use (%) antihypertensive agents 26.6 38.8 27.9 8.9 45.9 24.7 26.2 lipid-lowering agents 2.4 4.3 2.0 0.6 3.4 2.3 2.4 diabetes agents 4.5 6.7 4.3 1.0 7.1 4.1 4.3 Physical characteristics BMI (kg/m2) 27.5 ± 5.2 26.5 ± 4.1 26.2 ± 4.1 27.7 ± 4.6 26.9 ± 4.5 27.3 ± 4.9 27.2 ± 4.9 systolic BP (mmHg) 121.1 ± 18.6 136.3 ± 21.4 135.6 ± 18.6 122.0 ± 16.3 134.7 ± 22.1 124.6 ± 19.6 125.3 ± 20.0 diastolic BP (mmHg) 73.9 ± 11.2 71.3 ± 11.5 75.9 ± 9.8 78.0 ± 9.7 73.6 ± 11.5 74.3 ± 11.1 74.3 ± 11.1 LVH (%) 4.8 3.4 1.2 0.3 3.4 3.5 3.5 Laboratory values creatinine calibrated (mg/dl) 0.9 ± 0.2 0.9 ± 0.3 0.9 ± 0.3 0.8 ± 0.2 1.3 ± 0.3 0.8 ± 0.2 0.9 ± 0.2 GFR (ml/min per 1.73 m2) 93.3 ± 19.8 79.9 ± 22.0 83.2 ± 28.3 98.7 ± 28.3 51.7 ± 7.6 93.9 ± 21.4 90.8 ± 23.4 total cholesterol (mg/dl) 214 ± 42 212 ± 39 230 ± 41 233 ± 47 224 ± 46 218 ± 43 218 ± 43 HDL cholesterol (mg/dl) 52 ± 17 56 ± 16 51 ± 15 49 ± 13 52 ± 16 52 ± 16 52 ± 16 Table 2. Baseline characteristics and outcomes by race and level of kidney functiona
Baseline Variables GFR Group (ml/min per 1.73 m2) White Black 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 ± 11.3 56.3 ± 11.7 66.7 ± 11.9 55.8 ± 8.6 male 33.0 45.5 33.3 38.8 high school graduate 71.8 83.3 54.1 59.7 Lifestyle (%) smoking, current 15.0 24.9 22.6 28.0 alcohol, current 55.3 66.4 23.9 34.0 Medical history (%) diabetes 12.4 7.4 28.3 16.7 hypertension 59.4 33.4 88.1 57.2 Medication use (%) antihypertensive agents 42.3 20.7 79.2 41.4 lipid-lowering agents 3.4 2.5 3.7 1.4 diabetes agents 5.5 2.8 22.2 10.0 Physical characteristics BMI (kg/m2) 26.7 ± 4.3 26.8 ± 4.5 29.2 ± 5.7 29.2 ± 5.9 systolic BP (mmHg) 133.9 ± 21.6 123.3 ± 18.9 143.0 ± 25.6 129.3 ± 20.9 diastolic BP (mmHg) 73.0 ± 11.2 73.1 ± 10.5 79.4 ± 12.5 79.4 ± 11.9 LVH (%) 2.6 2.0 11.9 9.2 Laboratory values creatinine calibrated (mg/dl) 1.3 ± 0.3 0.8 ± 0.2 1.6 ± 0.5 0.9 ± 0.2 GFR (ml/min per 1.73 m2) 51.9 ± 7.3 91.9 ± 20.9 49.6 ± 10.0 102.0 ± 21.5 total cholesterol (mg/dl) 225 ± 45 219 ± 42 216 ± 47 214 ± 44 HDL cholesterol (mg/dl) 52 ± 16 52 ± 16 54 ± 18 56 ± 17 Clinical outcomes (%) MI/fatal CHD 9.7 5.5 13.8 4.6 stroke 7.3 2.6 9.4 3.7 all-cause mortality 22.5 7.9 27.7 8.7 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 % events 10.1% (168/1664) 5.3% (1111/20970) person-years at risk 12,125 169,779 events per 1000 person-years 13.9 6.5 Stroke % events 7.5% (125/1664) 2.8% (587/20970) person-years at risk 12,168 171,470 events per 1000 person-years 10.3 3.4 All-cause mortality % events 23.0% (383/1664) 8.1% (1693/20970) person-years at risk 12,450 172,926 events per 1000 person-years 30.8 9.8 Compositea % events 30.1% (500/1664) 13.2% (2762/20970) person-years at risk 11,887 168,459 events per 1000 person-years 42.1 16.4 Table 4. Hazard ratio for outcomes in patients with CKD in the fully adjusted modela
Outcome Hazard Ratio (95% CI) P Value P 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 all 1.09 (0.91 to 1.29) 0.35 0.003 white 1.01 (0.84 to 1.21) 0.94 black 2.09 (1.33 to 3.26) 0.001 Stroke all 1.17 (0.95 to 1.44) 0.13 0.90 white 1.17 (0.94 to 1.45) 0.17 black 1.21 (0.71 to 2.08) 0.48 MI/FCHD/stroke all 1.10 (0.95 to 1.26) 0.20 0.004 white 1.03 (0.89 to 1.19) 0.70 black 1.78 (1.25 to 2.54) 0.001 All-cause mortality all 1.36 (1.21 to 1.53) <0.001 0.053 white 1.31 (1.16 to 1.49) <0.001 black 1.83 (1.33 to 2.52) <0.001 Composite all 1.19 (1.07 to 1.32) 0.001 0.002 white 1.13 (1.02 to 1.26) 0.02 black 1.76 (1.35 to 2.31) <0.001
Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies
Jump to section
More in this TOC Section
Cited By...
- Genetic overlap and causal inferences between kidney function and cerebrovascular disease
- Disentangling the multiple links between renal dysfunction and cerebrovascular disease
- In reply: Is diabetes still a compelling indication for renin-angiotensin-aldosterone system inhibitors?
- American Association of Clinical Endocrinologists/American College of Endocrinology Management of Dyslipidemia and Prevention of Cardiovascular Disease Clinical Practice Guidelines
- BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD
- Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association
- MicroRNA-92a Mediates Endothelial Dysfunction in CKD
- Association of QT-Prolonging Medication Use in CKD with Electrocardiographic Manifestations
- eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study
- APOL1 Risk Variants and Cardiovascular Disease: Results From the AASK (African American Study of Kidney Disease and Hypertension)
- APOL1 and Cardiovascular Disease: A Story in Evolution
- Carbamylated Low-Density Lipoproteins Induce a Prothrombotic State Via LOX-1: Impact on Arterial Thrombus Formation In Vivo
- Silent Cerebral Microbleeds and Longitudinal Risk of Renal and Cardiovascular Events in Patients with CKD
- What drives quality improvement in chronic kidney disease (CKD) in primary care: process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) trial
- Chronic Renal Insufficiency Cohort Study (CRIC): Overview and Summary of Selected Findings
- Cause-Specific Deaths in Non-Dialysis-Dependent CKD
- Change in Multiple Filtration Markers and Subsequent Risk of Cardiovascular Disease and Mortality
- Added Value of Screening for CKD among the Elderly or Persons with Low Socioeconomic Status
- Metabolically Healthy Obesity and Risk of Incident CKD
- Cardiac Myocyte-Derived Follistatin-Like 1 Prevents Renal Injury in a Subtotal Nephrectomy Model
- ESRD and Death after Heart Failure in CKD
- Intradialytic Hypotension and Risk of Cardiovascular Disease
- Risk of End-Stage Renal Disease and Death After Cardiovascular Events in Chronic Kidney Disease
- The Impact of Acute Kidney Injury on the Long-term Risk of Stroke
- Proposal for a Functional Classification System of Heart Failure in Patients With End-Stage Renal Disease: Proceedings of the Acute Dialysis Quality Initiative (ADQI) XI Workgroup
- Increased Burden of Cardiovascular Disease in Carriers of APOL1 Genetic Variants
- Fibroblast Growth Factor-23 and the Long-Term Risk of Hospital-Associated AKI among Community-Dwelling Older Individuals
- Recognition of CKD After the Introduction of Automated Reporting of Estimated GFR in the Veterans Health Administration
- Impact of Chronic Kidney Disease on Carotid Atherosclerosis According to Blood Pressure Category: The Suita Study
- Prognostic Value of LA Volumes Assessed by Transthoracic 3D Echocardiography: Comparison With 2D Echocardiography
- Impact on cardiovascular risk follow-up from a shift to the CKD-EPI formula for eGFR reporting: a cross-sectional population-based primary care study
- Elevated Galectin-3 Precedes the Development of CKD
- Kindlin-2: A New Player in Renal Fibrogenesis
- Galectin-3 and New-Onset CKD: Marker or Mediator?
- Disentangling the Ultrafiltration Rate-Mortality Association: The Respective Roles of Session Length and Weight Gain
- Serum {beta}-2 microglobulin predicts mortality in people with diabetes
- A Piece of the Puzzle in the Cardiorenal Conundrum
- Identification of chromosome 3q28 and ALPK1 as susceptibility loci for chronic kidney disease in Japanese individuals by a genome-wide association study
- Renal Impairment and Ischemic Stroke Risk Assessment in Patients With Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project
- Cardiorenal Syndrome: The Emerging Role of Protein-Bound Uremic Toxins
- Racial differences in albuminuria, kidney function, and risk of stroke
- Electrocardiogram Abnormalities and Cardiovascular Mortality in Elderly Patients with CKD
- Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease
- Chronic Kidney Disease and Risk for Presenting With Acute Myocardial Infarction Versus Stable Exertional Angina in Adults With Coronary Heart Disease
- Effects of Beta-Adrenergic Antagonists in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis
- Screening for Proteinuria: A Tool for Predicting Rapid Declines in Kidney Function?
- Cardiovascular Disease Among Hispanics and Non-Hispanics in the Chronic Renal Insufficiency Cohort (CRIC) Study
- Racial and Ethnic Differences in Mortality among Individuals with Chronic Kidney Disease: Results from the Kidney Early Evaluation Program (KEEP)
- GFR Decline and Mortality Risk among Patients with Chronic Kidney Disease
- Chronic Kidney Disease in Octogenarians
- Chronic Kidney Disease as a Coronary Disease Equivalent--A Comparison with Diabetes over a Decade
- Associations among Estimated Glomerular Filtration Rate, Proteinuria, and Adverse Cardiovascular Outcomes
- Longitudinal Association of Depressive Symptoms with Rapid Kidney Function Decline and Adverse Clinical Renal Disease Outcomes
- Association of Decreased Glomerular Filtration Rate with Racial Differences in Survival after Acute Myocardial Infarction
- The Increasing Prevalence of Atrial Fibrillation among Hemodialysis Patients
- Cystatin C Identifies Chronic Kidney Disease Patients at Higher Risk for Complications
- A Multi-Marker Approach to Predict Incident CKD and Microalbuminuria
- Low Socioeconomic Status Associates with Higher Serum Phosphate Irrespective of Race
- Fibroblast Growth Factor 23 and Fetuin A are Independent Predictors for the Coronary Artery Disease Extent in Mild Chronic Kidney Disease
- Low glomerular filtration rate and risk of stroke: meta-analysis
- Rate of ESRD Exceeds Mortality among African Americans with Hypertensive Nephrosclerosis
- Chronic Kidney Disease as a Potent Risk Modifier for CAD in Diabetics
- Renal Function and Risk Stratification of Diabetic and Nondiabetic Patients Undergoing Evaluation for Coronary Artery Disease
- Mobilized Human Hematopoietic Stem/Progenitor Cells Promote Kidney Repair After Ischemia/Reperfusion Injury
- Serum Creatinine and Glomerular Filtration Rate: Perception and Reality
- Uromodulin Levels Associate with a Common UMOD Variant and Risk for Incident CKD
- Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis
- Change in Estimated GFR Associates with Coronary Heart Disease and Mortality
- Rapid Decline of Kidney Function Increases Cardiovascular Risk in the Elderly
- CKD Associates with Cognitive Decline
- Association of Dialysis Modality and Cardiovascular Mortality in Incident Dialysis Patients
- Increased Risk of Acute Myocardial Infarction for Patients With Panic Disorder: A Nationwide Population-Based Study
- Relationship Between Blood Pressure Category and Incidence of Stroke and Myocardial Infarction in an Urban Japanese Population With and Without Chronic Kidney Disease: The Suita Study
- Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study
- Kidney function and the risk of cardiovascular disease
- Outcomes Associated with Race in Males with Nondialysis-Dependent Chronic Kidney Disease
- Association of Genetic Variants with Chronic Kidney Disease in Japanese Individuals
- Cystatin C Associates with Arterial Stiffness in Older Adults
- Impact of Proteinuria and Glomerular Filtration Rate on Risk of Thromboembolism in Atrial Fibrillation: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study