Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study.

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Date

2017-05-17

Authors

He, Jiang
Shlipak, Michael
Anderson, Amanda
Roy, Jason A
Feldman, Harold I
Kallem, Radhakrishna Reddy
Kanthety, Radhika
Kusek, John W
Ojo, Akinlolu
Rahman, Mahboob

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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.

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CRIC (Chronic Renal Insufficiency Cohort) Investigators, Kidney, Humans, Albuminuria, Anemia, Diabetes Mellitus, Insulin Resistance, Inflammation, Creatinine, Glomerular Filtration Rate, Prognosis, Incidence, Risk Assessment, Risk Factors, Comorbidity, Time Factors, Adult, Aged, Middle Aged, United States, Female, Male, Renal Insufficiency, Chronic, Heart Failure, Cystatin C, Young Adult, Biomarkers

Citation

Published Version (Please cite this version)

10.1161/JAHA.116.005336

Publication Info

He, Jiang, Michael Shlipak, Amanda Anderson, Jason A Roy, Harold I Feldman, Radhakrishna Reddy Kallem, Radhika Kanthety, John W Kusek, et al. (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). 10.1161/JAHA.116.005336 Retrieved from https://hdl.handle.net/10161/18483.

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Scholars@Duke

Wolf

Myles Selig Wolf

Charles Johnson, M.D. Distinguished Professor of Medicine

The focus of my research is disordered mineral metabolism across the spectrum of chronic kidney disease, including dialysis, kidney transplantation and earlier stages.

My research has been published in leading general medicine and subspecialty journals, including the New England Journal of Medicine, JAMA, the Journal of Clinical Investigation, Circulation, Cell Metabolism, Journal of the American Society of Nephrology, and Kidney International, among others.

My primary contributions have been in the area of hormonal regulation of phosphate homeostasis. I have helped to characterize the physiological role of fibroblast growth factor 23 in health and in chronic kidney disease, and the impact of elevated fibroblast growth factor 23 levels on adverse clinical outcomes in patients with kidney disease.


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