Decreased eGFR was associated with increased cardiovascular mortality (RR 1.22 per 5 ml/min/1.73 m2 decrease), which attenuated to RR 1.12 after adjusting for markers of endothelial dysfunction.
Cohort (n=613)
Endothelial dysfunction is related to mild renal insufficiency and partially explains the excess cardiovascular mortality observed in these patients.
Relative Risk: 1.22
Mildly impaired renal function is associated with cardiovascular morbidity and mortality. There are indications that endothelial dysfunction and/or chronic inflammation, which play an important role in atherothrombosis, are present in early stages of renal insufficiency. This study investigated whether and to which extent endothelial dysfunction and inflammation were related to renal function and contributed to renal function-associated cardiovascular mortality in a population-based cohort (n = 613), aged 50 to 75 yr, that was followed with a median duration of 12.5 yr. During follow-up, 192 individuals died (67 of cardiovascular causes). At baseline, renal function was estimated with serum creatinine, the Cockcroft-Gault formula, and the Modification of Diet in Renal Disease equation of GFR (eGFR). Endothelial function was estimated by plasma von Willebrand factor, soluble vascular cell adhesion molecule-1, and the urinary albumin-creatinine ratio. Inflammatory activity was estimated by plasma C-reactive protein and soluble intercellular adhesion molecule-1. Renal function was mildly impaired (mean eGFR 68 +/- 12 ml/min per 1.73 m(2)) and independently associated with von Willebrand factor (standardized beta -0.09; 95% confidence interval CI -0.18 to -0.002; P < 0.05), soluble vascular cell adhesion molecule-1 (standardized beta -0.14; 95% CI -0.22 to -0.05; P < 0.01), and albumin-creatinine ratio (standardized beta -0.15; 95% CI -0.23 to -0.08; P < 0.001) but not with markers of inflammatory activity. Renal function was inversely associated with cardiovascular and all-cause mortality. The relative risk for cardiovascular mortality but not all-cause mortality associated with renal function decreased from 1.22 to 1.12 per 5 ml/min per 1.73 m(2) decrease of eGFR after adjustment for markers of endothelial dysfunction. In conclusion, endothelial dysfunction was related to renal function and contributed to the excess in cardiovascular mortality in this population-based cohort with mild renal insufficiency.
Stam et al. (Thu,) conducted a cohort in Mild renal insufficiency (n=613). Decreased estimated glomerular filtration rate (eGFR) vs. Higher eGFR was evaluated on Cardiovascular mortality (RR 1.22). Decreased eGFR was associated with increased cardiovascular mortality (RR 1.22 per 5 ml/min/1.73 m2 decrease), which attenuated to RR 1.12 after adjusting for markers of endothelial dysfunction.