Rapid Kidney Function Decline and Mortality Risk in Older Adults

Abstract

Chronic kidney disease (CKD) is a major and growing public health problem, with an estimated 17% of the adult US population affected.¹ Multiple studies, including those in older adults, have shown that prevalent CKD defined as an estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m² is a strong independent risk factor for cardiovascular disease and all-cause mortality.^2-4 However, few studies have evaluated the association of long-term changes in kidney function with future cardiovascular events. In a recent analysis from the Cardiovascular Health Study (CHS),⁵ participants with mild kidney dysfunction (cystatin C level >1.0 mg/L and eGFR >60 mL/min/1.73 m²) whose disease progressed to CKD (eGFR 2) had a higher adjusted risk for cardiovascular events and mortality than individuals whose disease did not progress. In contrast to these studies, change in serum creatinine concentration was not independently associated with cardiovascular outcomes in the Heart and Estrogen/Progestin Replacement Study⁶ after adjustment for baseline creatinine level.