Risk factors for heart failure in patients with chronic kidney disease

The CRIC (Chronic Renal Insufficiency Cohort) study

for the CRIC (Chronic Renal Insufficiency Cohort) Investigators

Research output: Contribution to journalArticle

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-a (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.

Original languageEnglish (US)
Article numbere005336
JournalJournal of the American Heart Association
Volume6
Issue number5
DOIs
StatePublished - May 1 2017

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Chronic Renal Insufficiency
Glomerular Filtration Rate
Cohort Studies
Heart Failure
Cystatin C
Albuminuria
Creatinine
Insulin Resistance
Anemia
Kidney
Incidence
Albumins
Interleukin-6
Hemoglobins
Tumor Necrosis Factor-alpha
Urine
Inflammation
Serum

Keywords

  • Albuminuria
  • Chronic kidney disease
  • Glomerular filtration rate
  • Heart failure
  • Risk factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk factors for heart failure in patients with chronic kidney disease : The CRIC (Chronic Renal Insufficiency Cohort) study. / for the CRIC (Chronic Renal Insufficiency Cohort) Investigators.

In: Journal of the American Heart Association, Vol. 6, No. 5, e005336, 01.05.2017.

Research output: Contribution to journalArticle

@article{7861d23d8e9240448da6bf109f7510cb,
title = "Risk factors for heart failure in patients with chronic kidney disease: The CRIC (Chronic Renal Insufficiency Cohort) study",
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-a (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.",
keywords = "Albuminuria, Chronic kidney disease, Glomerular filtration rate, Heart failure, Risk factor",
author = "{for the CRIC (Chronic Renal Insufficiency Cohort) Investigators} and Jiang He and Michael Shlipak and Amanda Anderson and Roy, {Jason A.} and Feldman, {Harold I.} and Kallem, {Radhakrishna Reddy} and Radhika Kanthety and Kusek, {John W.} and Akinlolu Ojo and Mahboob Rahman and Ricardo, {Ana C.} and Soliman, {Elsayed Z.} and Myles Wolf and Xiaoming Zhang and Dominic Raj and Lee Hamm and Lawrence Appel and Go, {Alan S.} and Lash, {James P.} and Townsend, {Raymond R.}",
year = "2017",
month = "5",
day = "1",
doi = "10.1161/JAHA.116.005336",
language = "English (US)",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
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TY - JOUR

T1 - Risk factors for heart failure in patients with chronic kidney disease

T2 - The CRIC (Chronic Renal Insufficiency Cohort) study

AU - for the CRIC (Chronic Renal Insufficiency Cohort) Investigators

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 - Appel, Lawrence

AU - Go, Alan S.

AU - Lash, James P.

AU - Townsend, Raymond R.

PY - 2017/5/1

Y1 - 2017/5/1

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-a (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.

AB - 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-a (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.

KW - Albuminuria

KW - Chronic kidney disease

KW - Glomerular filtration rate

KW - Heart failure

KW - Risk factor

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U2 - 10.1161/JAHA.116.005336

DO - 10.1161/JAHA.116.005336

M3 - Article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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M1 - e005336

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