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Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study.
J Am Heart Assoc 2017; 6(5)JA

Abstract

BACKGROUND

Heart failure is common in patients with chronic kidney disease. We studied risk factors for incident heart failure among 3557 participants in the CRIC (Chronic Renal Insufficiency Cohort) Study.

METHODS AND RESULTS

Kidney function was assessed by estimated glomerular filtration rate (eGFR) using serum creatinine, cystatin C, or both, and 24-hour urine albumin excretion. During an average of 6.3 years of follow-up, 452 participants developed incident heart failure. After adjustment for age, sex, race, and clinical site, hazard ratio (95% CI) for heart failure associated with 1 SD lower creatinine-based eGFR was 1.67 (1.49, 1.89), 1 SD lower cystatin C-based-eGFR was 2.43 (2.10, 2.80), and 1 SD higher log-albuminuria was 1.65 (1.53, 1.78), all P<0.001. When all 3 kidney function measures were simultaneously included in the model, lower cystatin C-based eGFR and higher log-albuminuria remained significantly and directly associated with incidence of heart failure. After adjusting for eGFR, albuminuria, and other traditional cardiovascular risk factors, anemia (1.37, 95% CI 1.09, 1.72, P=0.006), insulin resistance (1.16, 95% CI 1.04, 1.28, P=0.006), hemoglobin A1c (1.27, 95% CI 1.14, 1.41, P<0.001), interleukin-6 (1.15, 95% CI 1.05, 1.25, P=0.002), and tumor necrosis factor-α (1.10, 95% CI 1.00, 1.21, P=0.05) were all significantly and directly associated with incidence of heart failure.

CONCLUSIONS

Our study indicates that cystatin C-based eGFR and albuminuria are better predictors for risk of heart failure compared to creatinine-based eGFR. Furthermore, anemia, insulin resistance, inflammation, and poor glycemic control are independent risk factors for the development of heart failure among patients with chronic kidney disease.

Authors+Show Affiliations

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA jhe@tulane.edu. Department of Medicine, Tulane University School of Medicine, New Orleans, LA.Department of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA.Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH.Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH.Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.Department of Medicine, University of Arizona Health Sciences, Tucson, AZ.Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH.Department of Medicine, University of Illinois at Chicago, IL.Department of Epidemiology and Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC.Department of Medicine, Duke University School of Medicine, Durham, NC.Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.Division of Renal Diseases and Hypertension, George Washington University, Washington, DC.Department of Medicine, Tulane University School of Medicine, New Orleans, LA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

28515118

Citation

He, Jiang, et al. "Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: the CRIC (Chronic Renal Insufficiency Cohort) Study." Journal of the American Heart Association, vol. 6, no. 5, 2017.
He J, Shlipak M, Anderson A, et al. Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study. J Am Heart Assoc. 2017;6(5).
He, J., Shlipak, M., Anderson, A., Roy, J. A., Feldman, H. I., Kallem, R. R., ... Hamm, L. (2017). Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study. Journal of the American Heart Association, 6(5), doi:10.1161/JAHA.116.005336.
He J, et al. Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: the CRIC (Chronic Renal Insufficiency Cohort) Study. J Am Heart Assoc. 2017 May 17;6(5) PubMed PMID: 28515118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study. AU - He,Jiang, AU - Shlipak,Michael, AU - Anderson,Amanda, AU - Roy,Jason A, AU - Feldman,Harold I, AU - Kallem,Radhakrishna Reddy, AU - Kanthety,Radhika, AU - Kusek,John W, AU - Ojo,Akinlolu, AU - Rahman,Mahboob, AU - Ricardo,Ana C, AU - Soliman,Elsayed Z, AU - Wolf,Myles, AU - Zhang,Xiaoming, AU - Raj,Dominic, AU - Hamm,Lee, AU - ,, Y1 - 2017/05/17/ PY - 2017/5/19/entrez PY - 2017/5/19/pubmed PY - 2018/3/13/medline KW - albuminuria KW - chronic kidney disease KW - glomerular filtration rate KW - heart failure KW - risk factor JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 6 IS - 5 N2 - BACKGROUND: Heart failure is common in patients with chronic kidney disease. We studied risk factors for incident heart failure among 3557 participants in the CRIC (Chronic Renal Insufficiency Cohort) Study. METHODS AND RESULTS: Kidney function was assessed by estimated glomerular filtration rate (eGFR) using serum creatinine, cystatin C, or both, and 24-hour urine albumin excretion. During an average of 6.3 years of follow-up, 452 participants developed incident heart failure. After adjustment for age, sex, race, and clinical site, hazard ratio (95% CI) for heart failure associated with 1 SD lower creatinine-based eGFR was 1.67 (1.49, 1.89), 1 SD lower cystatin C-based-eGFR was 2.43 (2.10, 2.80), and 1 SD higher log-albuminuria was 1.65 (1.53, 1.78), all P<0.001. When all 3 kidney function measures were simultaneously included in the model, lower cystatin C-based eGFR and higher log-albuminuria remained significantly and directly associated with incidence of heart failure. After adjusting for eGFR, albuminuria, and other traditional cardiovascular risk factors, anemia (1.37, 95% CI 1.09, 1.72, P=0.006), insulin resistance (1.16, 95% CI 1.04, 1.28, P=0.006), hemoglobin A1c (1.27, 95% CI 1.14, 1.41, P<0.001), interleukin-6 (1.15, 95% CI 1.05, 1.25, P=0.002), and tumor necrosis factor-α (1.10, 95% CI 1.00, 1.21, P=0.05) were all significantly and directly associated with incidence of heart failure. CONCLUSIONS: Our study indicates that cystatin C-based eGFR and albuminuria are better predictors for risk of heart failure compared to creatinine-based eGFR. Furthermore, anemia, insulin resistance, inflammation, and poor glycemic control are independent risk factors for the development of heart failure among patients with chronic kidney disease. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/28515118/Risk_Factors_for_Heart_Failure_in_Patients_With_Chronic_Kidney_Disease:_The_CRIC__Chronic_Renal_Insufficiency_Cohort__Study_ L2 - http://www.ahajournals.org/doi/full/10.1161/JAHA.116.005336?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -