CKD and cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study: interactions with age, sex, and race.
CKD and cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study: interactions with age, sex, and race.
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DOI：
10.1053/j.ajkd.2013.04.010
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发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
Coresh J
中科院分区：
文献类型：
--
作者：
Hui X;Matsushita K;Sang Y;Ballew SH;Fülöp T;Coresh J
Estimated glomerular filtration rate (eGFR) and albuminuria are central for diagnosis, staging, and risk evaluation in chronic kidney disease (CKD). Universal thresholds regardless of age, sex, and race are recommended, but relatively little is known about how these demographic factors alter the relationship of eGFR and albuminuria to cardiovascular outcomes. Observational cohort study. 11,060 whites and blacks aged 52–75 years in the Atherosclerosis Risk in Communities (ARIC) Study with median follow-up of 11.2 years. eGFR by the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (reference, 95 ml/min/1.73 m2) and urinary albumin-creatinine ratio (ACR) (reference, at 5 mg/g). Cardiovascular events (coronary disease, stroke, and heart failure) and all-cause mortality. Adjusted HRs associated with eGFR and ACR in subgroups according to age, sex and race. Cardiovascular risk significantly increased at eGFR <70 ml/min/1.73 m2 in all subgroups according to age (< 65 vs. ≥65 years), sex, and race (P for interaction >0.2 for these subgroups; e.g., at eGFR 30 ml/min/1.73 m2, the adjusted HR was 2.19 [95% CI, 1.10–4.35] at age 52–64 years vs. 2.23 [95% CI, 1.33–3.72] at age 65–75 years). Results were similar for mortality. Log(ACR) was linearly associated with cardiovascular risk without threshold effects in all subgroups, with some quantitative interactions. HRs according to ACR tended to be lower in men vs. women (e.g., at ACR 40 mg/g, 1.18 [95% CI, 0.98–1.41] vs. 1.77 [95% CI, 1.45–2.15]) and in older vs. younger population (1.24 [95% CI, 1.04–1.49] vs. 1.73 [95% CI, 1.42–2.12]) (P for interaction <0.01 for sex and age). Less evident interactions were observed for mortality. Single measurement of eGFR with creatinine and ACR and relatively narrow age range. The associations of eGFR and ACR with cardiovascular events were largely similar, with some quantitative interactions, among age, sex, and racial subgroups, generally supporting universal thresholds of GFR and ACR for CKD definition/staging.
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