Kidney function decline increases risk of heart failure and premature death

Nov 05, 2009

Declining kidney function is linked to a higher risk of heart failure, heart attack, peripheral arterial disease, and early death in individuals with or without kidney disease, according to a pair of studies appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The findings indicate that poor kidney function may raise an individual's risk for cardiovascular complications. To evaluate heart health, clinicians should factor in not only their patients' current level of kidney function, but also changes in kidney function over time.

Chronic kidney disease (CKD) patients have an increased risk of developing and dying from cardiovascular disease, but the links between kidney function and are not well understood. Michael Shlipak, MD (San Francisco VA Medical Center and University of California, San Francisco), Mark Sarnak, MD (Tufts-New England Medical Center), and their colleagues studied clinical information from individuals who were enrolled in the Cardiovascular Health Study, a community-based study of elderly people. Using a new blood test of kidney function, called cystatin C, the researchers looked for links between changes in kidney function during a period of seven years with the incidence of , heart attack, stroke, and peripheral arterial disease (obstruction of large arteries in the arms and legs) during the subsequent eight years. Among 4,378 eligible participants in the study, those with rapid kidney decline (1,083 patients) demonstrated a 32% increased risk of experiencing heart failure, a 48% increased risk of having a heart attack, and a 67% increased risk of developing peripheral arterial disease. (They did not have an increased risk of suffering a stroke.)

Importantly, researchers identified an association between rapid kidney function decline and heart complications in patients with and without CKD. Treatments that slow the decline of kidney function and stabilize it in the normal range, before kidney disease develops, could have substantial health benefits.

In the second study, Kunihiro Matsushita, MD, PhD, Josef Coresh, MD, PhD (Johns Hopkins University), and their colleagues examined the effects of changes in kidney function in 13,029 participants of the Atherosclerosis Risk in Communities (ARIC) Study, a population-based sample of individuals aged 45 to 64 years. The researchers followed patients from 1987 to 2006, and monitored participants' kidney function at the start of the study, three years into the study, and nine years into the study. Investigators found that a large drop in kidney function over time—regardless of the initial level of function—increased one's risk of developing heart disease and of dying early. Patients whose kidney function dropped by more than 5.6% per year demonstrated a 30% increased risk of developing heart disease and a 22% increased risk of dying prematurely compared to patients with stable kidney function.

Physicians regularly monitor kidney function in elderly patients and patients with diabetes and hypertension to optimize the dose of prescription drugs excreted by the kidneys. This study indicates that physicians who detect a decline in patients' kidney function over time should view this as a sign of increased risk of heart disease and premature death.

"Our results suggest there may be clinical value in sequential kidney function data, often measured in routine care, even among individuals with mildly reduced kidney function," the authors wrote.

More information: The articles, entitled "Rapid Decline of Increases Cardiovascular Risk in the Elderly" (doi 10.1681/ASN.2009050546) and "Change idoi 10.1681/ASN.2009010025 with Coronary Disease and Mortality" (doi 10.1681/ASN.2009010025) will appear online at http://jasn.asnjournals.org/ on November 5, 2009.

Source: American Society of Nephrology (news : web)

Explore further: Strategies needed to encourage appropriate antibiotic selection

add to favorites email to friend print save as pdf

Related Stories

Low thyroid function common in chronic kidney disease

Jun 11, 2008

Many patients with chronic kidney disease (CKD) have mild reductions in thyroid function, or subclinical hypothyroidism—a condition that becomes more common as kidney function declines, according to a study in the September ...

Kidney disease increases the risk of stroke in patients

Mar 04, 2009

Chronic kidney disease increases the risk of stroke in patients with atrial fibrillation (AF), the most common type of heart arrhythmia, according to a new study by Kaiser Permanente researchers in the current online issue ...

Can kidney disease cause cancer?

May 01, 2009

Moderate kidney disease increases an older man's risk of developing certain cancers, according to an upcoming study in the Journal of the American Society Nephrology (JASN). Given that chronic kidney disease (CKD) affect ...

Kidney disease affects response to blood thinner

Feb 18, 2009

Patients with reduced kidney function require lower doses of the anticoagulant drug warfarin, and may need closer monitoring to avoid serious bleeding complications, suggests a study in the April 2009 issue of the Journal of ...

Recommended for you

Liberia free of Ebola by Christmas, says president

6 hours ago

Liberia's president on Monday urged her countrymen to double their efforts to reach the government's goal of having zero new Ebola cases by Dec. 25, a target some experts have described as highly ambitious.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.