Abstract
ObjectiveWe examined the utility of the Kidney age–Chronological age Difference (KCD) score, an age-adapted measure of kidney function, to identify increased cardiovascular (CV) death or non-fatal CV event risk in participants of the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), a community-based cohort aged 23–95 years.DesignCohort study.SettingCommunity.Participants11205 randomly selected participants from urban and nonurban areas across Australia.Outcome measuresMortality status and underlying and contributory causes of death obtained from the Australian National Death Index, and non-fatal CV events from adjudicated hospital records. The association of CV death or non-fatal CV event risk with KCD score was examined using penalised spline curve analysis.ResultsOf 11 180 participants with serum creatinine measurement at baseline and 5-year outcome data, there were 308 CV deaths or non-fatal CV events after 5 years. Penalised spline curve analysis showed similar progressive increase in CV death or non-fatal CV event risk with increasing KCD score in men and women, and participants aged <50 years to ≥80 years. Receiver operating characteristic curve analysis showed optimal discrimination at a KCD score ≥20 years (KCD20) for all participants. Among 148 participants aged<70 years with CV death or non-fatal CV event, KCD20 identified 24 (16%) participants, whereas estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2identified 8 (5%) participants (p=0.0001), with specificities of 95% and 99%, respectively (p<0.0001).ConclusionKCD20 predicted CV death or non-fatal CV event risk similarly in men and women of different ages in this population-based cohort. The higher sensitivity for prediction of CV death or non-fatal CV event risk in participants aged <70 years by KCD20 than by eGFR <60 mL/min/1.73 m2offers opportunity for earlier renoprotective therapy in individuals with eGFR-associated increased CV death or non-fatal CV event risk.
Funder
Roche Diagnostics Australia
Sanofi Aventis
AstraZeneca
Alphapharm Pty Ltd
Department of Health – New South Wales
Department of Health – South Australia
Victorian Government’s OIS Program
Sanofi-Synthelabo
National Heart Foundation of Australia
City Health Centre-Diabetes Service-Canberra
Novartis Pharmaceuticals
Bristol-Myers Squibb
Australian Government Department of Health and Ageing
Queensland Health
Department of Health and Community Services - Northern Territory
Abbott Australasia Pty Ltd
Pfizer Pty Ltd
National Health and Medical Research Council
GlaxoSmithKline
Estate of the Late Edward Wilson
Novo Nordisk Pharmaceuticals
Royal Prince Alfred Hospital - Sydney
Pratt Foundation
Menzies Research Institute
Marian & FH Flack Trust
Diabetes Australia
Janssen-Cilag
Kidney Health Australia
Eli Lilly Australia
Diabetes Australia Northern Territory
Department of Human Services – Victoria
Merck Sharp and Dohme
Jack Brockhoff Foundation
Department of Health – Western Australia
Department of Health and Human Services – Tasmania