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Cardiovascular Risk Factors and Incident Acute Renal Failure in Older Adults: The Cardiovascular Health Study

Anuja Mittalhenkle^*, Catherine O. Stehman-Breen^,, Michael G. Shlipak, Linda F. Fried^||, Ronit Katz^¶, Bessie A. Young^**, Stephen Seliger^*, Daniel Gillen^¶, Anne B. Newman, Bruce M. Psaty^,**, and David Siscovick^,**

^* Division of Nephrology, Department of Medicine, Department of Epidemiology, School of Public Health, ^¶ Department of Biostatistics, ^** Department of Medicine, University of Washington, Seattle, Washington; Amgen, Thousand Oaks, Division of General Internal Medicine, Department of Medicine, Veterans Affairs Medical Center, and Department of Epidemiology and Biostatistics, University of California, San Francisco, California; ^|| Renal Section, Veterans Affairs Pittsburgh Healthcare System, and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health and the Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Correspondence: Dr. Anuja Mittalhenkle, Division of Nephrology & Hypertension, Mail Code MQ360, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239. Phone: 503-494-7880; Fax: 503-494-7695; E-mail: mittalhe{at}ohsu.edu

Background and objectives: Although the elderly are at increased risk for acute renal failure, few prospective studies have identified risk factors for acute renal failure in the elderly.

Design, setting, participants, & measurements: The associations of cardiovascular disease risk factors, subclinical cardiovascular disease, and clinical coronary heart disease with the risk for development of acute renal failure were examined in older adults in the Cardiovascular Health Study, a prospective cohort study of community-dwelling older adults. Incident hospitalized cases of acute renal failure were identified through hospital discharge International Classification of Diseases, Ninth Revision codes and confirmed through physician diagnoses of acute renal failure in discharge summaries.

Results: Acute renal failure developed in 225 (3.9%) of the 5731 patients during a median follow-up period of 10.2 yr. In multivariate analyses, diabetes, current smoking, hypertension, C-reactive protein, and fibrinogen were associated with acute renal failure. Prevalent coronary heart disease was associated with incident acute renal failure, and among patients without prevalent coronary heart disease, subclinical vascular disease measures were also associated with acute renal failure: Low ankle-arm index (0.9), common carotid intima-media thickness, and internal carotid intima-media thickness.

Conclusions: In this large, population-based, prospective cohort study, cardiovascular risk factors and both subclinical and clinical vascular disease were associated with incident acute renal failure in the elderly.