TY - JOUR
T1 - Kidney age - chronological age difference (KCD) score provides an age-adapted measure of kidney function
AU - Campbell, Duncan J.
AU - Coller, Jennifer M.
AU - Gong, Fei Fei
AU - McGrady, Michele
AU - Boffa, Umberto
AU - Shiel, Louise
AU - Liew, Danny
AU - Stewart, Simon
AU - Owen, Alice J.
AU - Krum, Henry
AU - Reid, Christopher M.
AU - Prior, David L.
N1 - Funding Information:
This research was supported by Bupa Australia, with subsequent support from the National Health and Medical Research Council of Australia (GTN0559010, GTN1044619, GTN1092642, GTN0395508 to D.J.C., GTN1045862, GTN1136372 to C.M.R., GTN1041796 to S.S., GTN0620241 to J.M.C., GNT0519456 to M.M.), the National Heart Foundation of Australia (G 07 M 3198, 102956) , the Diabetes Australia Research Trust (Y15G-CAMD), The University of Melbourne, St. Vincent’s Hospital Melbourne, St. Vincent’s Institute of Medical Research, and the Victorian Government’s Operational Infrastructure Support Program.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Given the age-related decline in glomerular filtration rate (GFR) in healthy individuals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an individual’s kidney age is estimated from their estimated GFR (eGFR) and the age-dependent eGFR decline reported for healthy living potential kidney donors. Methods: We examined the association between death or cardiovascular event and KCD score, age-dependent stepped eGFR criteria (eGFRstep), and eGFR < 60 ml/min/1.73 m2 (eGFR60) in a community-based high cardiovascular risk cohort of 3837 individuals aged ≥60 (median 70, interquartile range 65, 75) years, followed for a median of 5.6 years. Results: In proportional hazards analysis, KCD score ≥ 20 years (KCD20) was associated with increased risk of death or cardiovascular event in unadjusted analysis and after adjustment for age, sex and cardiovascular risk factors. Addition of KCD20, eGFRstep or eGFR60 to a cardiovascular risk factor model did not improve area under the curve for identification of individuals who experienced death or cardiovascular event in receiver operating characteristic curve analysis. However, addition of KCD20 or eGFR60, but not eGFRstep, to a cardiovascular risk factor model improved net reclassification and integrated discrimination. KCD20 identified individuals who experienced death or cardiovascular event with greater sensitivity than eGFRstep for all participants, and with greater sensitivity than eGFR60 for participants aged 60–69 years, with similar sensitivities for men and women. Conclusions: In this high cardiovascular risk cohort aged ≥60 years, the KCD score provided an age-adapted measure of kidney function that may assist patient education, and KCD20 provided an age-adapted criterion of eGFR-related increased risk of death or cardiovascular event. Further studies that include the full age spectrum are required to examine the optimal KCD score cut point that identifies increased risk of death or cardiovascular event, and kidney events, associated with impaired kidney function, and whether the optimal KCD score cut point is similar for men and women. Trial registration: ClinicalTrials.gov NCT00400257, NCT00604006, and NCT01581827.
AB - Background: Given the age-related decline in glomerular filtration rate (GFR) in healthy individuals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an individual’s kidney age is estimated from their estimated GFR (eGFR) and the age-dependent eGFR decline reported for healthy living potential kidney donors. Methods: We examined the association between death or cardiovascular event and KCD score, age-dependent stepped eGFR criteria (eGFRstep), and eGFR < 60 ml/min/1.73 m2 (eGFR60) in a community-based high cardiovascular risk cohort of 3837 individuals aged ≥60 (median 70, interquartile range 65, 75) years, followed for a median of 5.6 years. Results: In proportional hazards analysis, KCD score ≥ 20 years (KCD20) was associated with increased risk of death or cardiovascular event in unadjusted analysis and after adjustment for age, sex and cardiovascular risk factors. Addition of KCD20, eGFRstep or eGFR60 to a cardiovascular risk factor model did not improve area under the curve for identification of individuals who experienced death or cardiovascular event in receiver operating characteristic curve analysis. However, addition of KCD20 or eGFR60, but not eGFRstep, to a cardiovascular risk factor model improved net reclassification and integrated discrimination. KCD20 identified individuals who experienced death or cardiovascular event with greater sensitivity than eGFRstep for all participants, and with greater sensitivity than eGFR60 for participants aged 60–69 years, with similar sensitivities for men and women. Conclusions: In this high cardiovascular risk cohort aged ≥60 years, the KCD score provided an age-adapted measure of kidney function that may assist patient education, and KCD20 provided an age-adapted criterion of eGFR-related increased risk of death or cardiovascular event. Further studies that include the full age spectrum are required to examine the optimal KCD score cut point that identifies increased risk of death or cardiovascular event, and kidney events, associated with impaired kidney function, and whether the optimal KCD score cut point is similar for men and women. Trial registration: ClinicalTrials.gov NCT00400257, NCT00604006, and NCT01581827.
KW - All-cause mortality
KW - Cardiovascular disease
KW - Chronic kidney disease
KW - eGFR
UR - http://www.scopus.com/inward/record.url?scp=85104826693&partnerID=8YFLogxK
U2 - 10.1186/s12882-021-02324-y
DO - 10.1186/s12882-021-02324-y
M3 - Article
AN - SCOPUS:85104826693
VL - 22
JO - BMC Nephrology
JF - BMC Nephrology
SN - 1471-2369
IS - 1
M1 - 152
ER -