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Kidney Function Decline Increases Risk of Heart Failure, Even In People Without Kidney Disease

WASHINGTON, DC -- November 5, 2009 -- Declining kidney function is linked to a higher risk of heart failure, myocardial infarction (MI), peripheral arterial disease, and early death in individuals with or without kidney disease, according to a pair of studies published early online and appearing in an upcoming issue of the Journal of the American Society Nephrology.

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 heart health are not well understood.

Michael Shlipak, MD, San Francisco VA Medical Center, and University of California at San Francisco, San Francisco, California, and Mark Sarnak, MD, Tufts University New England Medical Center, Boston, Massachusetts, and 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 failure, MI, stroke, and peripheral arterial disease during the subsequent 8 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 MI, and a 67% increased risk of developing peripheral arterial disease. An increased risk of stroke was not observed.

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 stabilise it in the normal range, before kidney disease develops, could have substantial health benefits.

In the second study, Kunihiro Matsushita, MD, Josef Coresh, MD, from Johns Hopkins University, Baltimore, Maryland, and 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, 3 years into the study, and 9 years into the study.

They 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 optimise 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.

SOURCE: American Society of Nephrology

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