RT Journal Article
SR Electronic
T1 Association between renal function and cardiovascular mortality: a retrospective cohort study of elderly from health check-up
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e049307
DO 10.1136/bmjopen-2021-049307
VO 11
IS 9
A1 Huang, Ying-Jhen
A1 Hsu, Yu-Lin
A1 Chuang, Yung-Hsin
A1 Lin, Hugo Y -H
A1 Chen, Yen-Hsu
A1 Chan, Ta-Chien
YR 2021
UL http://bmjopen.bmj.com/content/11/9/e049307.abstract
AB Objectives This study aimed to investigate the relationship between cardiovascular mortality in elderly Asians and decline in renal function.Design A retrospective cohort study.Setting Community-based health examination database from Taipei city.Participants At the beginning, the database included 315 045 health check-up visits of 97 803 elderly persons aged ≥65 years old from 2005 to 2012. After excluding missing values and outliers, there were 64 732 elderly persons with at least two visits retained for further analyses.Primary outcome measures Kidney function indicators include estimated glomerular filtration rate (eGFR) and urine protein, and rapid decline in eGFR was defined as slope ≤ −5 mL/min/1.73 m2 per year. The endpoint outcome was defined as the cardiovascular deaths registered in the death registry encoded by the International Classification of Diseases. We applied a Cox proportional hazards model to analyse the association between renal function and cardiovascular mortality.Results In this study, we found 1264 elderly persons died from cardiovascular diseases, for whom the data included 4055 previous health check-up visits. We observed significant and independent associations of eGFR <60 mL/min/1.73 m2 (HR (95% CI) of 60>eGFR≥45 and eGFR<45 in males: 2.85 (1.33 to 6.09) and 3.98 (1.84 to 8.61); in females: 3.66 (1.32 to 10.15) and 6.77 (2.41 to 18.99)), positive proteinuria (HR (95% CI) of +/−, +,++ and +++, ++++ in males: 1.51 (1.29 to 1.78) and 2.31 (1.51 to 3.53); in females: 1.93 (1.54 to 2.42) and 4.23 (2.34 to 7.65)) and rapid decline in eGFR (HR (95% CI) in males: 3.24 (2.73 to 3.85); in females: 2.83 (2.20 to 3.64) with higher risk of cardiovascular mortality. The joint effect of increased concentration of urine protein and reduced eGFR was associated with a higher risk of cardiovascular mortality.Conclusions Renal function and rapid decline in renal function are independent risk factors for cardiovascular mortality in the elderly.Data may be obtained from a third party and are not publicly available. The raw data are confidential and cannot readily be shared. Researchers need to obtain permission from the Institutional Review Board and apply for access to the data from the Department of Health, Taipei City Government.