Association of kidney function and major adverse cardiovascular events in 470,453 elderly: insights from a community-based cohort study in China

Background : Data are sparse regarding the association between kidney function and major adverse cardiovascular events (MACE) among older adults. Methods : Within the Tianjin community residents Health Promotion Prospective Study, 470,453 participants without MACE were followed-up from 2014 to 2021. MACE was ascertained as the composite of nonfatal myocardial infarction (MI), nonfatal stroke or cardiovascular disease (CVD) death. The eGFR was calculated by serum creatinine (SCr) with formula at baseline and classified into four strata (< 30, 30-59, 60-89, ≥ 90 mL/min/1.73m 2 ). BP was measured annually and systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg was defined as BP poor-control. Data were analyzed using Cox model regression and mediation analysis. Results : During the follow-up, 50,403 participants (mean age = 67.95 ± 6.68 years, 54.90% female) developed incident MACE. Compared to ≥ 90 mL/min/1.73m 2 eGFR, the multi-adjusted hazards ratio (95% CI) for < 30 mL/min/1.73m 2 eGFR was 3.403 (3.014 to 3.842) of MACE, the multi-adjusted HR (95% CI) for the 30-59 mL/min/1.73m 2 eGFR was 1.393 (1.250 to 1.551) of MI, the multi-adjusted HR (95% CI) for 30-59 mL/min/1.73m 2 eGFR was 1.227 (1.141 to 1.320) of stroke, the multi-adjusted HR (95% CI) for < 30 mL/min/1.73m 2 eGFR was 4.134 (3.647 to 4.687) of CVD death. The association between eGFR and MACE was 17.57% mediated by BP poor-control. Conclusions : Poor kidney function was associated with increased risk of MACE and may be partially mediated by poorly control of BP among older adults.