Abstract P100: Kidney Health and Sudden Death Risk: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort
Objective: Chronic kidney disease (CKD) is a known risk factor for sudden death (SD). Recent improvements in the detection and classification of kidney disease using creatinine and cystatin C-based estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) have identified individuals with mild forms of kidney dysfunction who are at risk for adverse events. A comprehensive assessment of SD incidence across the spectrum of kidney health in a racially diverse population has not been performed.
Methods: The study was a prospective, longitudinal analysis among 27,296 participants ≥ 45 years (54% women, 40% Black) from across the continental US enrolled in the REGARDS study. Serum cystatin C and creatinine and urine albumin and creatinine were measured at baseline. SD was defined as sudden pulselessness from a presumed cardiac origin that occurred out of hospital or in the emergency room in a previously stable individual without other clear precipitating cause. Associations between estimated glomerular filtration rate (eGFR), derived from serum creatinine-cystatin C CKD-EPI, and urine albumin to creatinine ratio (UACR) and SD were estimated.
RESULTS: Over a mean follow-up of 5.8 ± 1.9 years, there were 335 SD. The annual incidence of SD increased across eGFR and ACR categories (from 1.2 to 5.2 per 1000-person years). Both eGFR and ACR were independently and additively associated with graded increases in SD risk after adjustment for sociodemographics, total cholesterol, HDL, statin use, blood pressure, anti-hypertensive medication, smoking, and heart failure (Table). Participants with mild decreases in eGFR (60-90 ml/min/1.73m2) combined with mild elevations in UACR (15-30 mg/g) were at significantly increased SD risk, and UACR <30mg/g identified individuals with normal eGFRs at higher SD risk.
Conclusion: Sensitive measures of eGFR and ACR provide a gradient of SD risk across the spectrum of kidney health.
Author Disclosures: R. Deo: None. E.Z. Soliman: None. Y. Khodneva: None. P.M. Muntner: None. W. McClellan: None. T.M. Brown: None. S.E. Judd: None. J.D. Rhodes: None. O.M. Gutierrez: None. M.G. Shlipak: None. C.M. Albert: None. M.M. Safford: B. Research Grant; Modest; Amgen, diaDexus.
- © 2015 by American Heart Association, Inc.