Abstract 3988: Reduced Kidney Function as a Risk Factor for Incident Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study
Background: The incidence of both heart failure (HF) and kidney failure are increasing. We sought to determine the effect of decreased kidney function on the incidence of HF in a population-based study of middle-aged adults; evidence from previous studies is restricted to those already at high risk for HF due to age or co-morbidities.
Methods: After exclusion of 747 participants with prevalent HF, 14,761 ARIC study participants were followed for incident HF hospitalization or death (ICD-9 428 and ICD-10 I50) from 1987 to 2002. Estimated glomerular filtration rate (eGFR, in ml/min/1.73m2) was calculated using the abbreviated MDRD Study equation and categorized following national guidelines as normal (≥ 90, n = 7,093), mildly reduced (60 - 89, n = 7,268), and moderately or severely reduced (< 60, n = 400). Cox Proportional Hazards models were used to control for demographic, traditional and novel cardiovascular risk factors. Analyses were also stratified by the presence of coronary heart disease (CHD) at the baseline examination.
Results: During the mean follow-up of 13 years, 1,200 participants developed HF. The incidence rates of HF were increased 3-fold for individuals with eGFR < 60 as compared to those with eGFR ≥ 90 (18 vs. 6 / 1,000 person-years). In individuals with eGFR < 60, about 20% of individuals without CHD at baseline and about 50% of those with CHD at baseline developed incident HF. The overall relative hazard of developing HF after multivariate adjustment was 2.02 (95% CI 1.56 - 2.63) for individuals with eGFR < 60 compared to those with eGFR ≥ 90. The relative hazard was also significantly increased both for individuals with and without evidence of CHD at baseline (Table 1⇓). We also found that estimated kidney function declined further subsequent to HF incidence.
Conclusions: Moderately or severely reduced kidney function (eGFR < 60) significantly increases the incidence of HF in this large, community-based, biracial study population of middle-aged adults.