Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction
Authors
Newsome, Britt B.Warnock, David G.
McClellan, William M.
Herzog, Charles A.
Kiefe, Catarina I.
Eggers, Paul W.
Allison, Jeroan J.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2008-03-26Keywords
AgedAged, 80 and over
Cohort Studies
Creatinine
Female
Hospitalization
Humans
Kidney Failure, Chronic
Male
Myocardial Infarction
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Bioinformatics
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: Although small changes in creatinine level during hospitalization have been associated with risk of short-term mortality, associations with posthospitalization end-stage renal disease (ESRD) and long-term mortality are unknown. We assessed the relationship between change in serum creatinine levels up to 3.0 mg/dL and death and ESRD among elderly survivors of hospitalization for acute myocardial infarction. METHODS: Retrospective cohort study of a nationally representative sample of Medicare beneficiaries admitted with acute myocardial infarction to nonfederal US hospitals between February 1994 and July 1995. Outcomes were mortality and ESRD through June 2004. RESULTS: The 87 094 eligible patients admitted to 4473 hospitals had a mean age of 77.1 years; for the 43.2% with some creatinine increase, quartiles of increase were 0.1, 0.2, 0.3 to 0.5, and 0.6 to 3.0 mg/dL. Incidence of ESRD and mortality ranged from 2.3 and 139.1 cases per 1000 person-years, respectively, among patients with no increase to 20.0 and 274.9 cases per 1000 person-years in the highest quartile of creatinine increase. Compared with patients without creatinine increase, adjusted hazard ratios by quartile of increase were 1.45, 1.97, 2.36, and 3.26 for ESRD and 1.14, 1.16, 1.26, and 1.39 for mortality, with no 95% confidence intervals overlapping 1.0 for either end point. CONCLUSION: In a nationally representative sample of elderly patients discharged after hospitalization for acute myocardial infarction, small changes in serum creatinine level during hospitalization were associated with an independent higher risk of ESRD and death.Source
Arch Intern Med. 2008 Mar 24;168(6):609-16. Link to article on publisher's siteDOI
10.1001/archinte.168.6.609Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47183PubMed ID
18362253Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1001/archinte.168.6.609