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Original Investigation
July 10, 2006

Renal Function and Heart Failure Risk in Older Black and White Individuals: The Health, Aging, and Body Composition Study

Author Affiliations

Author Affiliations: Division of General Internal Medicine, San Francisco General Hospital, San Francisco, Calif (Dr Bibbins-Domingo); Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco (Drs Bibbins-Domingo, Chertow, Cummings and Shlipak); The Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pa (Dr Fried); The Renal-Electrolyte Division (Dr Fried) and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health and the Division of Geriatric Medicine (Dr Newman), University of Pittsburgh School of Medicine, Pittsburgh; General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco (Ms Odden and Dr Shlipak); Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Kritchevsky); Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Md (Dr Harris); Department of Preventive Medicine, University of Tennessee, Memphis (Dr Satterfield); and California Pacific Medical Center Research Institute, San Francisco (Dr Cummings).

Arch Intern Med. 2006;166(13):1396-1402. doi:10.1001/archinte.166.13.1396

Background  Chronic kidney disease is a risk factor for heart failure, an association that may be particularly important in blacks who are disproportionately affected by both processes. Our objective was to determine whether the association of chronic kidney disease with incident heart failure differs between blacks and whites.

Methods  The study population comprised participants in the Health, Aging, and Body Composition Study without a diagnosis of heart failure (1124 black and 1676 white community-dwelling older persons). The main predictors were quintiles of cystatin C and creatinine concentrations and estimated glomerular filtration rate. The main outcome measure was incident heart failure.

Results  Over a mean 5.7 years, 200 participants developed heart failure. High concentrations of cystatin C and low estimated glomerular filtration rate were each associated with heart failure, but the magnitude was greater for blacks than for whites (cystatin C concentration: adjusted hazard ratio for quintile 5 [≥1.18 mg/dL] vs quintile 1 [<0.84 mg/dL] was 3.0 [95% confidence interval 1.4-6.5] in blacks and 1.4 [95% confidence interval, 0.8-2.5] in whites; estimated glomerular filtration rate: adjusted hazard ratio for quintile 5 (<59.2 mL/min) vs quintile 1 (>86.7 mL/min) was 2.7 [95% confidence interval, 1.4-4.9] in blacks and 1.8 [95% confidence interval, 0.9-3.6] in whites). For cystatin C, this association was observed at more modest decrements in kidney function among blacks as well. The population attributable risk of heart failure was 47% for blacks with moderate or high concentrations of cystatin C (≥0.94 mg/dL) (56% prevalence) but only 5% among whites (64% prevalence).

Conclusion  The association of kidney dysfunction with heart failure appears stronger in blacks than for whites, particularly when cystatin C is used to measure kidney function.