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November 5, 2009

Kidney Function Decline Increases Risk of Coronary Heart Disease and Premature Death

Declining kidney function may increase an individual’s risk for heart attack, peripheral arterial disease and early death even among those without kidney disease, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The study examined changes in kidney function over time and is one of two new studies examining the connection between declining kidney function and an increased risk of cardiovascular disease. Both were published November 5 in the Journal of the American Society Nephrology (JASN).

“In contrast to the large number of studies documenting an association between baseline kidney function and future cardiovascular events, little is known about whether sequential changes in kidney function are associated with future risk. We, for the first time, investigated this association in a middle-aged population in the U.S. Since clinicians often monitor kidney function over a period of years, we think our findings are clinically relevant,” said Kunihiro Matsushita, MD, PhD, lead author of the study and a post doctoral fellow at with the Bloomberg School’s Department of Epidemiology.

For the study, Johns Hopkins researchers examined the effects of changes in glomerular filtration rates—a measure of kidney function—in 13,029 participants of the Atherosclerosis Risk in Communities (ARIC). The population-based study sampled of individuals aged 45 to 64 years from 1987 to 2006. Researcher monitored the kidney function of participants at the start of the study, three years into the study, and nine years into the study. Analysis of the data determined that a large drop in kidney function over time was closely associated with an increased risk of developing heart disease and early death regardless of the initial kidney function level. A 5.6 percent per year drop in kidney function was associated with a 30 percent increased risk of developing coronary heart disease and a 22 percent increased risk of premature death compared to patients with stable kidney function.

“Chronic kidney disease has a wide range of severity and its mild and moderate forms are largely undiagnosed. The National Kidney Disease Education Program has good educational materials on diagnosing and staging kidney disease. Our data add information about how to interpret progressive declines in kidney function over time,” said Josef Coresh, MD, PhD, MHS, professor in the Bloomberg School of Public Health departments of Epidemiology and Biostatistics, and the senior Johns Hopkins author on the study.

Additional authors of the article “Change in Estimated GFR and Risk of Coronary Heart Disease and Mortality” include Elizabeth Selvin, PhD; Lori Bash, PhD; and Brad Astor, PhD; of Johns Hopkins and Nora Franceschini, MD, from the University of North Carolina.

The ARIC Study was supported by the National Heart, Lung, and Blood Institute. The researchers were supported by grants from the Japan Society for the Promotion of Science; the National of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; and the National Heart, Lung, and Blood Institute, National Institutes of Health.

Similar results were obtained in an independent study using another marker of kidney function. Researchers at University of San Francisco and Tufts University found that in a community-based study of 4,378 elderly people those with a rapid decline in kidney function were at increased risk of developing heart failure, heart attack, and peripheral arterial disease.

Public Affairs media contact for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons at 410-955-7619 or tmparson@jhsph.edu.