Original Report: Patient-Oriented, Translational Research American
Journal of
Nephrology
Received: January 29, 2015 Accepted: May 15, 2015 Published online: June 30, 2015
Am J Nephrol 2015;41:409–417 DOI: 10.1159/000433450
Kidney Measures with Diabetes and Hypertension on Cardiovascular Disease: The Atherosclerosis Risk in Communities Study Nadine Alexander a Kunihiro Matsushita a Yingying Sang a Shoshana Ballew a Bakhtawar K. Mahmoodi c Brad C. Astor b Josef Coresh a
a
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., b Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis., USA; c Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Abstract Background: Whether the association of chronic kidney disease (CKD) with cardiovascular risk differs based on diabetes mellitus (DM) and hypertension (HTN) status remains unanswered. Methods: We investigated 11,050 participants from the Atherosclerosis Risk in Communities Study (fourth examination (1996–1998)) with follow-up for cardiovascular outcomes (coronary disease, heart failure and stroke) through 2009. Using the Cox regression models, we quantified cardiovascular risk associated with estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) in individuals with and without DM and/or HTN and assessed their interactions. Results: Individuals with DM and HTN generally had higher cardiovascular risk relative to those without at all the levels of eGFR and ACR. Cardiovascular risk increased with lower eGFR and higher ACR regardless of DM and HTN status (e.g. adjusted hazards ratio (HR) for eGFR 30–44 vs. 90–104 ml/min/1.73 m2, 2.32 (95% CI, 1.66–3.26) in non-diabetics vs. 1.83 (1.25–2.67) in diabetics and 2.45 (2.20–5.01) in non-hypertensives vs. 1.51 (1.27–1.81) in hypertensives and corresponding adjusted
© 2015 S. Karger AG, Basel 0250–8095/15/0415–0409$39.50/0 E-Mail [email protected] www.karger.com/ajn
HR for ACR 30–299 vs.
Journal of
Nephrology
Received: January 29, 2015 Accepted: May 15, 2015 Published online: June 30, 2015
Am J Nephrol 2015;41:409–417 DOI: 10.1159/000433450
Kidney Measures with Diabetes and Hypertension on Cardiovascular Disease: The Atherosclerosis Risk in Communities Study Nadine Alexander a Kunihiro Matsushita a Yingying Sang a Shoshana Ballew a Bakhtawar K. Mahmoodi c Brad C. Astor b Josef Coresh a
a
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., b Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wis., USA; c Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Abstract Background: Whether the association of chronic kidney disease (CKD) with cardiovascular risk differs based on diabetes mellitus (DM) and hypertension (HTN) status remains unanswered. Methods: We investigated 11,050 participants from the Atherosclerosis Risk in Communities Study (fourth examination (1996–1998)) with follow-up for cardiovascular outcomes (coronary disease, heart failure and stroke) through 2009. Using the Cox regression models, we quantified cardiovascular risk associated with estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) in individuals with and without DM and/or HTN and assessed their interactions. Results: Individuals with DM and HTN generally had higher cardiovascular risk relative to those without at all the levels of eGFR and ACR. Cardiovascular risk increased with lower eGFR and higher ACR regardless of DM and HTN status (e.g. adjusted hazards ratio (HR) for eGFR 30–44 vs. 90–104 ml/min/1.73 m2, 2.32 (95% CI, 1.66–3.26) in non-diabetics vs. 1.83 (1.25–2.67) in diabetics and 2.45 (2.20–5.01) in non-hypertensives vs. 1.51 (1.27–1.81) in hypertensives and corresponding adjusted
© 2015 S. Karger AG, Basel 0250–8095/15/0415–0409$39.50/0 E-Mail [email protected] www.karger.com/ajn
HR for ACR 30–299 vs.
