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Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community

Guruprasad Manjunath, MD^*, Hocine Tighiouart, MS, Hassan Ibrahim, MD, Bonnie MacLeod, BS, Deeb N. Salem, MD, John L. Griffith, PhD, Josef Coresh, MD, PhD^||, Andrew S. Levey, MD^* and Mark J. Sarnak, MD^*,*

^* Division of Nephrology, Boston, Massachusetts, USA
Division of Clinical Care Research, Boston, Massachusetts, USA
Division of Cardiology, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
^|| Johns Hopkins School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

View larger version (19K): [in a new window]   Figure 1 (A) Kaplan-Meier survival analysis for atherosclerotic cardiovascular disease (ASCVD) stratified by level of glomerular filtration rate (GFR). (B) Kaplan-Meier survival analysis for de novo ASCVD stratified by level of GFR. (C) Kaplan-Meier survival analysis for recurrent ASCVD stratified by level of GFR. (D) Kaplan-Meier survival analysis for all-cause mortality stratified by level of GFR.

View larger version (13K): [in a new window]   Figure 2 Smoothed five-year predicted probability of developing atherosclerotic cardiovascular disease by level of glomerular filtration rate (GFR). Unadjusted curve shows the risk incorporating each individual’s value for 19 covariates in Table 3. Adjusted curve shows the average risk in the Atherosclerosis Risk in Communities study population if everyone had the GFR value on the X-axis. The linear model includes GFR as a continuous variable in a Cox regression while the cubic spline includes a cubic transition between linear segments with knots (at 0.05, 0.275, 0.5, 0.725, 0.95 quantiles of GFR) corresponding to GFR values of 63.7, 81.7, 88.2, 101.1, and 123.7 ml/min/1.73 m2, respectively. Tick marks along the X-axis indicate GFR values for individual participants (the marks form a solid bar in GFR regions with many individuals). A lower GFR cut-off of 30 ml/min/1.73 m2 was chosen because only 12 subjects had GFR values between 15 and 30 ml/min/1.73 m2; therefore, the data was less precise in the latter range.