Michael G. Shlipak, MD, MPH; Ronit Katz, PhD; Mark J. Sarnak, MD; Linda F. Fried, MD, MPH; Anne B. Newman, MD, MPH; Catherine Stehman-Breen, MD, MS; Stephen L. Seliger, MD; Brian Kestenbaum, MD; Bruce Psaty, MD, PhD; Russell P. Tracy, PhD; David S. Siscovick, MD, MPH
Grant Support: Drs. Shlipak, Fried, and Katz are funded by R01 HL073208-01. Dr. Shlipak is also supported by the American Federation for Aging Research and National Institute on Aging (Paul Beeson Scholars Program), by the Robert Wood Johnson Foundation (Generalist Faculty Scholars Program), and by R01 DK066488. Drs. Sarnak, Fried, Shlipak, Siscovick, and Newman are also supported by R01 AG027002. Dr. Fried is supported by an Advanced Research Career Development award from the Office of Research and Development, Clinical Science Research and Development, U.S. Department of Veterans Affairs. The Cardiovascular Health Study (CHS) is supported by contracts N01-HC-85079 through N01-HC-85086, N01-HC-35129, and N01-HC-15103 from the National Heart, Lung, and Blood Institute (NHLBI). A full list of participating CHS investigators and institutions can be found at http://www.chs-nhlbi.org.
Potential Financial Conflicts of Interest: Employment: C. Stehman-Breen (Amgen); Stock ownership or options (other than mutual funds): C. Stehman-Breen (Amgen).
Requests for Single Reprints: Michael G. Shlipak, MD, MPH, General Internal Medicine Section, Veterans Affairs Medical Center (111A1), 4150 Clement Street, San Francisco, CA 94121; e-mail, email@example.com.
Current Author Addresses: Dr. Shlipak: General Internal Medicine Section, Veterans Affairs Medical Center (111A1), 4150 Clement Street, San Francisco, CA 94121.
Dr. Katz: Collaborative Health Studies Coordinating Center, University of Washington, Box 354922, Building 29, Suite 310, 6200 NE 74th Street, Seattle, WA 98115.
Dr. Sarnak: Tufts-New England Medical Center, 750 Washington Street, Box 391, Boston, MA 02111.
Dr. Fried: Veterans Affairs Pittsburgh Healthcare System, University Drive, 111F-U, Pittsburgh, PA 15240.
Dr. Newman: Healthy Aging Research Program, Bellefield Professional Building, 130 North Bellefield Avenue, Room 532, Pittsburgh, PA 15213.
Dr. Stehman-Breen: Amgen, One Amgen Center Drive, Mailstop 38-3-C, Thousand Oaks, CA 91320.
Dr. Seliger: University of Maryland, N3W143, 22 South Greene Street, Baltimore, MD 21201.
Dr. Kestenbaum: Department of Medicine, Division of Nephrology, University of Washington, Veterans Affairs Puget Sound Health Care System, Mail Stop 111A, 1660 South Columbian Way, Seattle, WA 98108.
Drs. Psaty and Siscovick: Cardiovascular Health Research Unit, University of Washington, 1730 Minor Avenue, Suite 1360, Seattle, WA 98101-1448.
Dr. Tracy: University of Vermont College of Medicine, Colchester Research Facility, 208 South Park Drive, Suite 2, Colchester, VT 05446.
Author Contributions: Conception and design: M.G. Shlipak, M.J. Sarnak, A.B. Newman, C. Stehman-Breen, B. Kestenbaum, B. Psaty, R.P. Tracy, D.S. Siscovick.
Analysis and interpretation of the data: M.G. Shlipak, R. Katz, M.J. Sarnak, L.F. Fried, C. Stehman-Breen, S.L. Seliger, B. Psaty, D.S. Siscovick.
Drafting of the article: M.G. Shlipak, R. Katz, D.S. Siscovick.
Critical revision of the article for important intellectual content: M.G. Shlipak, R. Katz, M.J. Sarnak, L.F. Fried, A.B. Newman, C. Stehman-Breen, S.L. Seliger, B. Kestenbaum, B. Psaty, R.P. Tracy, D.S. Siscovick.
Final approval of the article: M.G. Shlipak, R. Katz, M.J. Sarnak, L.F. Fried, A.B. Newman, C. Stehman-Breen, S.L. Seliger, B. Kestenbaum, B. Psaty, R.P. Tracy, D.S. Siscovick.
Provision of study materials or patients: B. Psaty, R.P. Tracy, D.S. Siscovick.
Statistical expertise: R. Katz.
Obtaining of funding: M.G. Shlipak, R.P. Tracy.
Administrative, technical, or logistic support: M.G. Shlipak, R.P. Tracy.
Collection and assembly of data: R. Katz, B. Psaty, R.P. Tracy.
Shlipak MG, Katz R, Sarnak MJ, Fried LF, Newman AB, Stehman-Breen C, et al. Cystatin C and Prognosis for Cardiovascular and Kidney Outcomes in Elderly Persons without Chronic Kidney Disease. Ann Intern Med. 2006;145:237-246. doi: 10.7326/0003-4819-145-4-200608150-00003
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Published: Ann Intern Med. 2006;145(4):237-246.
Chronic kidney disease is a worldwide health problem that carries a substantial risk for cardiovascular morbidity and death. Chronic kidney disease has been defined as a creatinine-based estimated glomerular filtration rate (GFR) less than 60 mL/min per 1.73 m2(1), which represents a loss of more than half of normal kidney function. An estimated GFR less than 60 mL/min per 1.73 m2 has been strongly associated with cardiovascular risk and death (2). However, surprisingly little evidence supports an association of kidney function with adverse clinical events at GFR levels of 60 mL/min per 1.73 m2 or greater (1). The absence of risk associated with an estimated GFR of 60 mL/min per 1.73 m2 or greater may reflect a biological threshold effect—that milder reductions of actual GFR are clinically inconsequential—or may be due to inherent limitations of serum creatinine for estimating GFR (3-5).
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Cardiology, Geriatric Medicine, Nephrology, Chronic Kidney Disease, Prevention/Screening.
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