Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients

A 10-year follow-up study

Ellen K. Hoogeveen, Johanna M. Geleijnse, Erik J. Giltay, Sabita S. Soedamah-Muthu, Janette de Goede, Linda M. Oude Griep, Theo Stijnen, Daan Kromhout

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Abstract

Chronic kidney disease (CKD) is highly prevalent among older post-myocardial infarction (MI) patients. It is not known whether CKD is an independent risk factor for mortality in older post-MI patients with optimal cardiovascular drug-treatment. Therefore, we studied the relation between kidney function and all-cause and specific mortality among older post-MI patients, without severe heart failure, who are treated with state-of-the-art pharmacotherapy. From 2002-2006, 4,561 Dutch post-MI patients were enrolled and followed until death or January 2012. We estimated Glomerular Filtration Rate (EGFR) with cystatin C (cysC) and creatinine (cr) using the CKD-EPI equations and analyzed the relation with any and major causes of death using Cox models and restricted cubic splines. Mean (SD) for age was 69 years (5.6), 79% were men, 17% smoked, 21% had diabetes, 90% used antihypertensive drugs, 98% used antithrombotic drugs and 85% used statins. Patients were divided into four categories of baseline EGFRcysC: ≥90 (33%; reference), 60-89 (47%), 30-59 (18%), and <30 (2%) ml/min/1.73m2. Median follow-up was 6.4 years. During follow-up, 873 (19%) patients died: 370 (42%) from cardiovascular causes, 309 (35%) from cancer, and 194 (22%) from other causes. After adjustment for age, sex and classic cardiovascular risk factor, hazard ratios (95%-confidence intervals) for any death according to the four EGFRcysC categories were: 1 (reference), 1.4 (1.1-1.7), 2.9 (2.3-3.6) and 4.4 (3.0-6.4). The hazard ratios of all-cause and cause-specific mortality increased linearly below kidney functions of 80 ml/min/1.73 m2. Weaker results were obtained for EGFRcr. To conclude, we found in optimal cardiovascular drug-treated post-MI patients an inverse graded relation between kidney function and mortality for both cardiovascular as well as non-cardiovascular causes. Risk of mortality increased linearly below kidney function of about 80 ml/min/1.73 m2.

Original languageEnglish
Article numbere0171868
Number of pages17
JournalPLoS ONE
Volume12
Issue number2
DOIs
Publication statusPublished - 9 Feb 2017

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myocardial infarction
antineoplaston A10
renal function
Myocardial Infarction
Kidney
Drug therapy
Cardiovascular Agents
Mortality
kidney diseases
Chronic Renal Insufficiency
Hazards
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cystatin C
death
Medical problems
Splines
Antihypertensive Agents
risk factors
Creatinine
cystatins

Cite this

Hoogeveen, E. K., Geleijnse, J. M., Giltay, E. J., Soedamah-Muthu, S. S., de Goede, J., Oude Griep, L. M., ... Kromhout, D. (2017). Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients: A 10-year follow-up study. PLoS ONE, 12(2), [e0171868]. https://doi.org/10.1371/journal.pone.0171868
Hoogeveen, Ellen K. ; Geleijnse, Johanna M. ; Giltay, Erik J. ; Soedamah-Muthu, Sabita S. ; de Goede, Janette ; Oude Griep, Linda M. ; Stijnen, Theo ; Kromhout, Daan. / Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients : A 10-year follow-up study. In: PLoS ONE. 2017 ; Vol. 12, No. 2.
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abstract = "Chronic kidney disease (CKD) is highly prevalent among older post-myocardial infarction (MI) patients. It is not known whether CKD is an independent risk factor for mortality in older post-MI patients with optimal cardiovascular drug-treatment. Therefore, we studied the relation between kidney function and all-cause and specific mortality among older post-MI patients, without severe heart failure, who are treated with state-of-the-art pharmacotherapy. From 2002-2006, 4,561 Dutch post-MI patients were enrolled and followed until death or January 2012. We estimated Glomerular Filtration Rate (EGFR) with cystatin C (cysC) and creatinine (cr) using the CKD-EPI equations and analyzed the relation with any and major causes of death using Cox models and restricted cubic splines. Mean (SD) for age was 69 years (5.6), 79{\%} were men, 17{\%} smoked, 21{\%} had diabetes, 90{\%} used antihypertensive drugs, 98{\%} used antithrombotic drugs and 85{\%} used statins. Patients were divided into four categories of baseline EGFRcysC: ≥90 (33{\%}; reference), 60-89 (47{\%}), 30-59 (18{\%}), and <30 (2{\%}) ml/min/1.73m2. Median follow-up was 6.4 years. During follow-up, 873 (19{\%}) patients died: 370 (42{\%}) from cardiovascular causes, 309 (35{\%}) from cancer, and 194 (22{\%}) from other causes. After adjustment for age, sex and classic cardiovascular risk factor, hazard ratios (95{\%}-confidence intervals) for any death according to the four EGFRcysC categories were: 1 (reference), 1.4 (1.1-1.7), 2.9 (2.3-3.6) and 4.4 (3.0-6.4). The hazard ratios of all-cause and cause-specific mortality increased linearly below kidney functions of 80 ml/min/1.73 m2. Weaker results were obtained for EGFRcr. To conclude, we found in optimal cardiovascular drug-treated post-MI patients an inverse graded relation between kidney function and mortality for both cardiovascular as well as non-cardiovascular causes. Risk of mortality increased linearly below kidney function of about 80 ml/min/1.73 m2.",
author = "Hoogeveen, {Ellen K.} and Geleijnse, {Johanna M.} and Giltay, {Erik J.} and Soedamah-Muthu, {Sabita S.} and {de Goede}, Janette and {Oude Griep}, {Linda M.} and Theo Stijnen and Daan Kromhout",
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Hoogeveen, EK, Geleijnse, JM, Giltay, EJ, Soedamah-Muthu, SS, de Goede, J, Oude Griep, LM, Stijnen, T & Kromhout, D 2017, 'Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients: A 10-year follow-up study', PLoS ONE, vol. 12, no. 2, e0171868. https://doi.org/10.1371/journal.pone.0171868

Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients : A 10-year follow-up study. / Hoogeveen, Ellen K.; Geleijnse, Johanna M.; Giltay, Erik J.; Soedamah-Muthu, Sabita S.; de Goede, Janette; Oude Griep, Linda M.; Stijnen, Theo; Kromhout, Daan.

In: PLoS ONE, Vol. 12, No. 2, e0171868, 09.02.2017.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Kidney function and specific mortality in 60-80 years old post-myocardial infarction patients

T2 - A 10-year follow-up study

AU - Hoogeveen, Ellen K.

AU - Geleijnse, Johanna M.

AU - Giltay, Erik J.

AU - Soedamah-Muthu, Sabita S.

AU - de Goede, Janette

AU - Oude Griep, Linda M.

AU - Stijnen, Theo

AU - Kromhout, Daan

PY - 2017/2/9

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N2 - Chronic kidney disease (CKD) is highly prevalent among older post-myocardial infarction (MI) patients. It is not known whether CKD is an independent risk factor for mortality in older post-MI patients with optimal cardiovascular drug-treatment. Therefore, we studied the relation between kidney function and all-cause and specific mortality among older post-MI patients, without severe heart failure, who are treated with state-of-the-art pharmacotherapy. From 2002-2006, 4,561 Dutch post-MI patients were enrolled and followed until death or January 2012. We estimated Glomerular Filtration Rate (EGFR) with cystatin C (cysC) and creatinine (cr) using the CKD-EPI equations and analyzed the relation with any and major causes of death using Cox models and restricted cubic splines. Mean (SD) for age was 69 years (5.6), 79% were men, 17% smoked, 21% had diabetes, 90% used antihypertensive drugs, 98% used antithrombotic drugs and 85% used statins. Patients were divided into four categories of baseline EGFRcysC: ≥90 (33%; reference), 60-89 (47%), 30-59 (18%), and <30 (2%) ml/min/1.73m2. Median follow-up was 6.4 years. During follow-up, 873 (19%) patients died: 370 (42%) from cardiovascular causes, 309 (35%) from cancer, and 194 (22%) from other causes. After adjustment for age, sex and classic cardiovascular risk factor, hazard ratios (95%-confidence intervals) for any death according to the four EGFRcysC categories were: 1 (reference), 1.4 (1.1-1.7), 2.9 (2.3-3.6) and 4.4 (3.0-6.4). The hazard ratios of all-cause and cause-specific mortality increased linearly below kidney functions of 80 ml/min/1.73 m2. Weaker results were obtained for EGFRcr. To conclude, we found in optimal cardiovascular drug-treated post-MI patients an inverse graded relation between kidney function and mortality for both cardiovascular as well as non-cardiovascular causes. Risk of mortality increased linearly below kidney function of about 80 ml/min/1.73 m2.

AB - Chronic kidney disease (CKD) is highly prevalent among older post-myocardial infarction (MI) patients. It is not known whether CKD is an independent risk factor for mortality in older post-MI patients with optimal cardiovascular drug-treatment. Therefore, we studied the relation between kidney function and all-cause and specific mortality among older post-MI patients, without severe heart failure, who are treated with state-of-the-art pharmacotherapy. From 2002-2006, 4,561 Dutch post-MI patients were enrolled and followed until death or January 2012. We estimated Glomerular Filtration Rate (EGFR) with cystatin C (cysC) and creatinine (cr) using the CKD-EPI equations and analyzed the relation with any and major causes of death using Cox models and restricted cubic splines. Mean (SD) for age was 69 years (5.6), 79% were men, 17% smoked, 21% had diabetes, 90% used antihypertensive drugs, 98% used antithrombotic drugs and 85% used statins. Patients were divided into four categories of baseline EGFRcysC: ≥90 (33%; reference), 60-89 (47%), 30-59 (18%), and <30 (2%) ml/min/1.73m2. Median follow-up was 6.4 years. During follow-up, 873 (19%) patients died: 370 (42%) from cardiovascular causes, 309 (35%) from cancer, and 194 (22%) from other causes. After adjustment for age, sex and classic cardiovascular risk factor, hazard ratios (95%-confidence intervals) for any death according to the four EGFRcysC categories were: 1 (reference), 1.4 (1.1-1.7), 2.9 (2.3-3.6) and 4.4 (3.0-6.4). The hazard ratios of all-cause and cause-specific mortality increased linearly below kidney functions of 80 ml/min/1.73 m2. Weaker results were obtained for EGFRcr. To conclude, we found in optimal cardiovascular drug-treated post-MI patients an inverse graded relation between kidney function and mortality for both cardiovascular as well as non-cardiovascular causes. Risk of mortality increased linearly below kidney function of about 80 ml/min/1.73 m2.

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