CLINICAL EPIDEMIOLOGY

Change in Estimated GFR Associates with Coronary Heart Disease and Mortality

Kunihiro Matsushita, Elizabeth Selvin, Lori D. Bash, Nora Franceschini, Brad C. Astor and Josef Coresh
JASN December 2009, 20 (12) 2617-2624; DOI: https://doi.org/10.1681/ASN.2009010025

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Distribution of percentage annual change in eGFR on the basis of 3-yr change among 13,029 participants of the ARIC Study is shown. Cutoff points of quartiles were −5.65, −0.47, and −0.33%/yr.

  • Figure 2.
    Figure 2.

    (A and B) Adjusted incidence rates and their 95% CIs of CHD (A) and all-cause mortality (B) are shown by quartiles of percentage annual changes in eGFR (Q1 through Q4) from visit 1 to visit 2 (3-yr change) or visit 4 (9-yr change). Cutoff points of quartiles were −5.65, −0.47, and −0.33%/yr for 3-yr change and −2.46, −0.74, and −0.56%/yr for 9-yr change. Adjusted to mean age (54.0 yr), race (white), and gender (male).

Tables

  • Table 1.

    Characteristics of participants according to quartiles of change in eGFR from visit 1 to visit 2

    CharacteristicQuartiles of % Annual Change in eGFR
    Q1 (−52.76 to −5.65; n = 3258)Q2 (−5.65 to −0.47; n = 3257)Q3 (−0.47 to −0.33; n = 3257)Q4 (−0.33 to 42.94; n = 3257)
    Age (yr; mean ± SD)54.0 ± 5.853.8 ± 5.853.2 ± 5.154.9 ± 6.0
    Male gender (%)32.351.740.747.1
    Black race (%)27.825.820.424.4
    Educational level (%)a
        <12 yr completed22.420.718.422.2
        12 to 16 yr completed41.840.742.941.5
        >16 yr completed35.838.638.736.3
    Current smokers (%)a24.723.724.124.9
    Current alcohol drinkers (%)a54.457.761.157.4
    BMI (kg/m2; mean ± SD)a27.5 ± 5.527.5 ± 4.927.3 ± 5.227.9 ± 5.4
    Diabetes mellitus (%)12.28.68.011.5
    Antihypertensive medication (%)a28.526.424.929.9
    ACEI (%)a3.02.72.73.0
    SBP (mmHg; mean ± SD)a121.9 ± 20.1121.2 ± 17.8118.5 ± 16.9120.3 ± 17.5
    DBP (mmHg; mean ± SD)a73.5 ± 11.474.4 ± 10.972.8 ± 10.673.3 ± 10.7
    LDL cholesterol (mg/dl; mean ± SD)a134.0 ± 38.8137.9 ± 39.1136.9 ± 38.5138.7 ± 39.1
    HDL cholesterol (mg/dl; mean ± SD)a53.7 ± 17.351.3 ± 16.352.8 ± 17.451.4 ± 16.9
    TG (mg/dl; median [IQR])a106 (75, 152.5)107 (78, 152)106 (78, 152)113 (80, 158)
    Left ventricular hypertrophy (%)a2.42.01.22.0
    Carotid atherosclerosis (%)a8.57.45.57.0
    Serum creatinine (mg/dl; mean ± SD)
        visit 10.75 ± 0.200.87 ± 0.150.85 ± 0.170.93 ± 0.19
        visit 20.96 ± 0.470.97 ± 0.160.85 ± 0.170.84 ± 0.18
    eGFR (ml/min per 1.73 m2; mean ± SD)
        visit 1105.9 ± 23.291.5 ± 16.091.1 ± 16.984.0 ± 17.0
        visit 280.3 ± 18.580.0 ± 14.090.1 ± 16.794.3 ± 20.5

    • All comparisons were significant at P < 0.001, except for current smoking (P = 0.016), angiotensin-converting enzyme inhibitors (ACEI; P = 0.829), and left ventricular hypertrophy (P = 0.002). BMI, body mass index; SBP, systolic BP; DBP, diastolic BP; IQR, interquartile range; TG, triglycerides.

    • ↵aMissing values (number missing): Educational level, 20; current smokers, 8; current drinkers, 43; BMI, 7; diabetes, 19; antihypertensive medication, 6; ACEI, 1; SBP, 3; DBP, 4; LDL cholesterol, 258; HDL cholesterol, 84; TG, 83; left ventricular hypertrophy, 303; carotid atherosclerosis, 386.

  • Table 2.

    Adjusted HRs (95% CIs) of CHD and all-cause death by quartiles of % annual change in eGFR from visit 1 to visit 2, overall, and eGFR category at visit 1

    OutcomesQuartiles of % Annual Change in eGFR
    Q1 (−52.76 to −5.65)Q2 (−5.65 to −0.47)Q3 (−0.47 to −0.33)Q4 (−0.33 to 42.94)
    All
        na3016301230042985
        CHD1.30 (1.11 to 1.52)1.16 (1.00 to 1.35)Reference1.04 (0.90 to 1.22)
        all-cause mortality1.22 (1.06 to 1.41)1.05 (0.92 to 1.21)Reference1.10 (0.96 to 1.27)
    eGFR ≥90 ml/min per 1.73 m2
        na226213631247826
        CHD1.13 (0.91 to 1.41)1.19 (0.95 to 1.49)Reference0.98 (0.75 to 1.28)
        all-cause mortality0.96 (0.80 to 1.16)0.93 (0.76 to 1.13)Reference1.00 (0.80 to 1.23)
    eGFR 60 to <90 ml/min per 1.73 m2
        na716160417201996
        CHD1.39 (1.09 to 1.76)1.10 (0.90 to 1.36)Reference1.06 (0.87 to 1.29)
        all-cause mortality1.40 (1.12 to 1.76)1.10 (0.90 to 1.35)Reference1.18 (0.97 to 1.42)
    eGFR 30 to <60 ml/min per 1.73 m2
        na374437163
        CHD1.47 (0.46 to 4.67)1.68 (0.56 to 4.99)reference1.16 (0.43 to 3.10)
        all-cause mortality4.69 (1.28 to 17.16)4.98 (1.36 to 18.25)reference2.52 (0.73 to 8.74)

    • Adjusted for following covariates at visit 1: Age, race, gender, level of education, carotid atherosclerosis, SBP, antihypertensive medication, diabetes, smoking, alcohol intake, BMI, LDL cholesterol, HDL cholesterol, left ventricular hypertrophy, and eGFR.

    • ↵aParticipants included in the fully adjusted analysis.

  • Table 3.

    Adjusted HR (95% CIs) of CHD and all-cause mortality by quartiles of % annual change in eGFR from visit 1 to visit 4

    OutcomesQuartiles of % Annual Change in eGFR
    Q1 (−25.53 to −2.46)Q2 (−2.46 to −0.74)Q3 (−0.74 to −0.56)Q4 (−0.56 to 13.54)
    Adjustment for covariates at visit 1
        na2326231623392335
        CHD1.32 (1.08 to 1.63)1.06 (0.86 to 1.30)Reference1.18 (0.97 to 1.45)
        all-cause mortality1.41 (1.16 to 1.72)1.11 (0.90 to 1.36)Reference1.11 (0.90 to 1.36)
    Adjustment for covariates at visit 4
        na1190113011311048
        CHD1.17 (0.87 to 1.58)1.11 (0.84 to 1.48)Reference1.32 (0.99 to 1.74)
        all-cause mortality1.27 (0.97 to 1.67)0.98 (0.74 to 1.30)Reference1.05 (0.80 to 1.39)

    • Adjusted for following covariates at either visit: Age, race, gender, level of education, carotid atherosclerosis, SBP, antihypertensive medication, diabetes, smoking, alcohol intake, BMI, LDL cholesterol, HDL cholesterol, left ventricular hypertrophy, and eGFR.

    • ↵aParticipants included in the fully adjusted analysis.

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Change in Estimated GFR Associates with Coronary Heart Disease and Mortality
Kunihiro Matsushita, Elizabeth Selvin, Lori D. Bash, Nora Franceschini, Brad C. Astor, Josef Coresh
JASN Dec 2009, 20 (12) 2617-2624; DOI: 10.1681/ASN.2009010025
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