March 1, 2002Journal of the American Society of Nephrology834 citations
View Full PaperRenal Insufficiency and Subsequent Death Resulting from Cardiovascular Disease in the United States
Key Result
Renal insufficiency, defined as an estimated GFR <70 ml/min, was independently associated with an increased risk of cardiovascular disease-related death (HR 1.68; 95% CI 1.33-2.13).
Study Design
Type
Cohort (n=8,786)
Multicenter
Yes
Structured PICO
Does renal insufficiency increase the risk of cardiovascular disease-related and all-cause mortality in the general population?
P
Population
Participants 30 to 74 years of age at baseline (1976-1980) from the Second National Health and Nutrition Examination Survey Mortality Study, with urinary protein dipstick measurements (n = 8786) or serum creatinine levels of <=3.0 mg/dl (n = 6354).
I
Intervention
Renal insufficiency (defined by urinary protein levels 30 to 299 or >=300 mg/dl, or estimated GFR <70 ml/min)
C
Comparator
Normal renal function (urinary protein <30 mg/dl or estimated GFR >=90 ml/min)
O
Outcome
Cardiovascular disease-related mortality and all-cause mortalityhard clinical
Renal insufficiency, indicated by reduced GFR or proteinuria, is an independent risk factor for cardiovascular and all-cause mortality in the general US population.
Main Result
Effect estimate: HR 1.68 (95% CI 1.33-2.13)
Absolute Event Rate: 20.5% vs 4.1%
Abstract
Several epidemiologic studies reported that persons with renal insufficiency might have increased cardiovascular disease-related mortality rates in select populations. The association between renal insufficiency and increased cardiovascular disease-related and all-cause mortality rates during 16 yr of follow-up monitoring was examined among participants who were 30 to 74 yr of age at the baseline examinations in 1976 to 1980, with urinary protein dipstick measurements (n = 8786) or serum creatinine levels of or=300 mg/dl and were 4.1, 8.6, and 20.5 deaths/1000 person-yr among participants with estimated GFR of >or=90, 70 to 89, and or=300 mg/dl, respectively, compared with or=90 ml/min, those with estimated GFR of <70 ml/min exhibited higher relative risks of death from cardiovascular disease and all causes 1.68 (1.33 to 2.13) and 1.51 (1.19 to 1.91), respectively. This study indicates that, in a representative sample of the United States general population, renal insufficiency is independently associated with increased cardiovascular disease-related and all-cause mortality rates.