Estimated glomerular filtration rate as an independent predictor of atherosclerotic vascular disease in older women

Joshua R Lewis,Peter L Thompson,Richard L Prince,Kun Zhu,Wai Lim,Satvinder S Dhaliwal,Ee Mun Lim

doi:10.1186/1471-2369-13-58

Abstract

BackgroundEstimated glomerular filtration rate (eGFR) levels have been shown to predict atherosclerotic vascular disease hospitalization and mortality. We sought to investigate the role of renal function in the prediction of 10-year atherosclerotic vascular hospitalization and deaths in an unselected population of elderly women in and compared these predictions to Framingham equations.MethodsComplete 10-year verified mortality and hospitalization discharge records for atherosclerotic vascular disease was collected for a prospective study of 1,239 unselected female subject’s ≥ 70 from the Calcium Intake Fracture Outcome Study (CAIFOS) with 10 years of follow-up. eGFR was compared to the current Framingham risk scores.ResultsThe eGFR at baseline using the Modification of Diet in Renal Disease Study (MDRD) equation was 65.2 ± 14.5 mL/min/1.73 m2 and 66.3 ± 13.5 mL/min/1.73 m2 using the Chronic Kidney Disease EPIdemiology (CKD-EPI) equation. Over 10 years 30% of participants sustained an ASVD hospitalization or death. For every standard deviation (SD) reduction in eGFR using MDRD the odds ratio (OR) for ASVD hospitalization and deaths increased by 1.34 (1.18-1.53), P < 0.001and 1.31 (1.14-1.50), P < 0.001 in a model adjusted for Framingham 10-year general cardiovascular risk. Addition of eGFR by the MDRD equation to Framingham risk factors improved the net reclassification index by 5.9%, P = 0.018 and the integrated discrimination improvement by 0.010 ± 0.003, P < 0.001 Similar results were seen using the CKD-EPI equation.ConclusionEstimated glomerular filtration rate predicts ASVD outcomes independently of Framingham risk score predictions in elderly women and improves clinical prediction particularly of early ASVD.

Highlights

Estimated glomerular filtration rate levels have been shown to predict atherosclerotic vascular disease hospitalization and mortality
The development of equations to estimate renal function using age and serum creatinine has shown that estimated glomerular filtration rate is an important predictor of clinical Atherosclerotic vascular disease (ASVD) outcomes, especially mortality, when Estimated glomerular filtration rate (eGFR) falls below 60 ml/min/1.73 m2 [1,2,3] and is associated with all cause and cardiovascular mortality in general
Participants who sustained an ASVD event over the 10 years of the study had lower baseline values for eGFR by the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease (CKD)-EPI equations and higher values for age, body mass index, prevalent diabetes, systolic blood pressure and previous history of ASVD

Summary

Introduction

Estimated glomerular filtration rate (eGFR) levels have been shown to predict atherosclerotic vascular disease hospitalization and mortality. We sought to investigate the role of renal function in the prediction of 10year atherosclerotic vascular hospitalization and deaths in an unselected population of elderly women in and compared these predictions to Framingham equations. The development of equations to estimate renal function using age and serum creatinine has shown that estimated glomerular filtration rate (eGFR) is an important predictor of clinical ASVD outcomes, especially mortality, when eGFR falls below 60 ml/min/1.73 m2 [1,2,3] and is associated with all cause and cardiovascular mortality in general. The study design employed used both the revised MDRD and the CKD-EPI equations to examine the relationship of eGFR to atherosclerotic vascular disease in unselected elderly women using complete adjudicated hospital record discharge data from the Western Australian Data Linkage System. In addition the eGFR calculations were compared to the Framingham general cardiovascular risk model

Methods

Results

Discussion

Conclusion