Abstract. Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four publicly available, community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were indirectly calibrated across studies. CKD was defined by a GFR between 15 and 60 ml/min per 1.73 m 2 . A composite of myocardial infarction, fatal coronary heart disease, stroke, and death was the primary study outcome. Cox proportional hazards models were used to adjust for study, demographic variables, educational status, and other cardiovascular risk factors.The total population included 22,634 subjects; 18.4% of the population was black, and 7.4% had CKD. There were 3262 events. In adjusted analyses, CKD was an independent risk factor for the composite study outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.32), and there was a significant interaction between kidney function and race. Black individuals with CKD had an adjusted HR of 1.76 (95% CI, 1.35-2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02-1.26). CKD is a risk factor for the composite outcome of all-cause mortality and cardiovascular disease in the general population and a more pronounced risk factor in blacks than in whites. It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals.Chronic kidney disease (CKD) is a major public health problem. On the basis of clinical practice guidelines established by the National Kidney Foundation,~20 million adults in the United States have CKD, with 8 million of these classified as having moderate or severe kidney disease (1).In dialysis patients, cardiovascular disease (CVD) mortality rates are 10 to 30 times higher than in the general population (2). In high-risk patients, defined by the presence of either CVD or cardiovascular risk factors, less severe kidney disease is also an independent risk factor for CVD outcomes (3-12). However, in more representative community-based populations that were not selected for being at increased risk for CVD, there have been less consistent findings. Data from some studies suggest the absence of an independent association between the presence of CKD and CVD (13,14), whereas other data suggest that CKD is an independent risk factor for CVD outcomes (15-18). Previous studies may have been limited by insufficient power to examine subgroup relationships, in particular race, which may have caused discrepancies in these results.The purpose of the present study was to pool the findings from several large community-based cohort studies to evaluate more systematically whether CKD, as quantified by estimated GFR, ...

The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study.

Uric acid may mediate aspects of the relationship between hypertension and kidney disease via renal vasoconstriction and systemic hypertension. To investigate the relationship between uric acid and subsequent reduced kidney function, limited-access data of 13,338 participants with intact kidney function in two community-based cohorts, the Atherosclerosis Risks in Communities and the Cardiovascular Health Study, were pooled. Mean baseline serum uric acid was 5.9 Ϯ 1.5 mg/dl, mean baseline serum creatinine was 0.9 Ϯ 0.2 mg/dl, and mean baseline estimated GFR was 90.4 Ϯ 19.4 ml/min/1.73 m 2 . During 8.5 Ϯ 0.9 yr of follow-up, 712 (5.6%) had incident kidney disease defined by GFR decrease (Ն15 ml/min/1.73 m 2 with final GFR Ͻ60 ml/min/1.73 m 2 ), while 302 (2.3%) individuals had incident kidney disease defined by creatinine increase (Ն0.4 mg/dl with final serum creatinine Ͼ1.4 mg/dl in men and 1.2 mg/dl in women). In GFR-and creatinine-based logistic regression models, baseline uric acid level was associated with increased risk for incident kidney disease (odds ratio 1.07 [95% confidence interval 1.01 to 1.14] and 1.11 [95% confidence interval 1.02 to 1.21] per 1-mg/dl increase in uric acid, respectively), after adjustment for age, gender, race, diabetes, systolic BP, hypertension, cardiovascular disease, left ventricular hypertrophy, smoking, alcohol use, education, lipids, albumin, hematocrit, baseline kidney function and cohort; therefore, elevated serum uric acid level is a modest, independent risk factor for incident kidney disease in the general population.

Anemia is an independent risk factor for CVD outcomes in the ARIC cohort, a community cohort of subjects between the ages of 45 and 64 years.