Received December 18, 2006
Accepted on February 28, 2007
Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults
Bryan Kestenbaum *1,
Kyle D. Rudser 
,
Michael G. Shlipak 
,
Linda F. Fried 
,
Anne B. Newman ||,
Ronit Katz ¶,
Mark J. Sarnak *,
Stephen Seliger ,
Catherine Stehman-Breen ,
Ronald Prineas ,
and
David S. Siscovick ||||
*Division of Nephrology, Harborview Medical Center, Department of Biostatistics, and ||||Departments of Medicine and Epidemiology, Cardiovascular Health Research Unit, University of Washington, and ¶Collaborative Health Studies Coordinating Center, Seattle, Washington; University of California San Francisco, General Internal Medicine Section, Veterans Affairs Medical Center, University of California, San Francisco, California; Veterans Affairs Pittsburgh Healthcare System and Renal-Electrolyte Division, University of Pittsburgh School of Medicine, and ||University of Pittsburgh, Department of Epidemiology, Pittsburgh, Pennsylvania; *Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts; University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland; Amgen Inc., Thousand Oaks, California; and Section on Epidemiology, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
1 To whom correspondence should be addressed. E-mail: brk{at}u.washington.edu.
 |
Abstract |
|---|
Chronic kidney disease (CKD) is associated with cardiovascular (CV) disease and mortality. It is not known whether cardiac rhythm disturbances are more prevalent among individuals with CKD or whether resting electrocardiogram findings predict future CV events in the CKD setting. Data were obtained from the Cardiovascular Health Study, a community-based study of adults aged 
65 yr. After exclusions for prevalent heart disease, atrial fibrillation, implantable pacemaker, or antiarrhythmic medication use, 3238 participants were analyzed. CKD was defined by an estimated GFR <60 ml/min per 1.73 m2. Outcomes were adjudicated incident heart failure (HF), incident coronary heart disease (CHD), and mortality. Participants with CKD had longer PR and corrected QT intervals compared with those without CKD; however, differences in electrocardiographic markers were explained by traditional CV risk factors and CV medication use. After adjustment for known risk factors, each 10-ms increase in the QRS interval was associated with a 15% greater risk for incident HF (95% confidence interval [CI] 1.04 to 1.27), a 13% greater risk for CHD (95% CI 1.04 to 1.24), and a 17% greater risk for mortality (95% CI 1.09, 1.25) among CKD participants. Each 5% increase in QTI was associated with a 42% (95% CI 1.23 to 1.65), 22% (95% CI 1.07 to 1.40), and 10% (95% CI 0.98 to 1.22) greater risk for HF, CHD, and mortality, respectively. Associations seemed stronger for participants with CKD; however, no significant interactions were detected. Resting electrocardiographic abnormalities are common in CKD and independently predict future clinical CV events in this setting.
