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  • Title: Association between renal function and cardiovascular and all-cause mortality in the community-based elderly population: results from the Specific Health Check and Guidance Program in Japan.
    Author: Kon S, Konta T, Ichikawa K, Asahi K, Yamagata K, Fujimoto S, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Iseki K, Moriyama T, Kondo M, Watanabe T.
    Journal: Clin Exp Nephrol; 2018 Apr; 22(2):346-352. PubMed ID: 28744566.
    Abstract:
    BACKGROUND: Chronic kidney disease is a significant risk factor for end-stage kidney disease, cardiovascular events, and premature death. However, the prognostic value of low estimated glomerular filtration rate (eGFR) in the elderly is debatable. METHODS: We determined eGFR using the Japanese equation in 132,160 elderly subjects (65-75 years) who attended the special health checkup (Tokutei-Kenshin) in 2008 and investigated the association between baseline eGFR and 5-year all-cause and cardiovascular mortality. RESULTS: The median (SD) eGFR was 70.5 ± 15.3 mL/min/1.73 m2. During follow-up, we noted 2045 all-cause deaths including 408 from cardiovascular events. A J-shaped curve was obtained when all-cause and cardiovascular mortality rates were compared with decreases in eGFR, with the highest mortality observed for eGFR <45 mL/min/1.73 m2. These trends were statistically significant in the Kaplan-Meier analysis (P < 0.001). In the Cox proportional hazard analysis, after adjusting for possible confounders, those with eGFR <45 mL/min/1.73 m2, but not eGFR 45-59 mL/min/1.73 m2 showed a higher all-cause and cardiovascular mortality than those with eGFR >90 mL/min/1.73 m2 [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.06-1.91 for all-cause mortality, HR 2.28, 95% CI 1.28-4.03 for cardiovascular mortality]. Sex-based subgroup analyses showed similar results for both men and women. CONCLUSIONS: We conclude that eGFR <45 mL/min/1.73 m2 is an independent risk factor for all-cause and cardiovascular mortality in the elderly population.
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