Mark J Sarnak

..To our knowledge, the effect of kidney function on successful aging has not been examined...

..Treatment of both traditional and uremia-related risk factors should be initiated in the earlier stages of CKD. Additional clinical trials with a goal to reduce CVD are urgently needed in CKD...

..Hypertension is a risk factor for progression of chronic kidney disease. The optimal blood pressure to slow progression is unknown...

..Waist-to-hip ratio (WHR) is less influenced by muscle and bone mass than body mass index (BMI). We compared WHR and BMI as risk factors for cardiac events (myocardial infarction and fatal coronary disease) in persons with CKD...

..Chronic kidney disease (CKD) and obesity are important public health concerns. We examined the association between anthropomorphic measures and incident CKD and mortality...

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..We sought to determine the utility of the Framingham equations in individuals with chronic kidney disease (CKD)...

..There are limited data on the prevalence of chronic kidney disease (CKD) and its clinical importance in the very old. We examined the prevalence of CKD in octogenarians and its association with cardiovascular disease (CVD)...

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..CRP levels are independently associated with serum albumin level and CVD prevalence. Inflammation may be involved in the pathophysiological state of malnutrition and CVD in the earlier stages of predominantly nondiabetic kidney disease...

..Obesity assessed in midlife has been associated with chronic kidney disease...

..To examine the association between kidney function and all-cause mortality in octogenarians...

..Chronic kidney disease is associated with increased risk for cardiovascular disease and mortality. Both traditional and nontraditional cardiovascular disease risk factors may contribute...

..Both depression and cognitive impairment are common in hemodialysis patients, are associated with adverse clinical outcomes, and place an increased burden on health care resources...

..Arm muscle area was used as an indicator of muscle mass...

..43; P = 0.07). HbA(1c) is associated with increased mortality in nondiabetic kidney disease. Hyperglycemia may be a potential therapeutic target and HbA(1c) may be important as a risk stratification tool in this high-risk population...

..Hyperuricemia is prevalent in patients with chronic kidney disease (CKD); however, data are limited about the relationship of uric acid levels with long-term outcomes in this patient population...

..Prior studies demonstrating an association between tHcy and CVD risk may have inadequately adjusted for the confounding effects of kidney function...

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..To study the associations of retinal microvascular changes, which are associated with systemic conditions and cognitive decline, with disability in performing activities of daily living (ADL)...

..03 to 1.31) of rapid decrease (p for interaction <0.001). In conclusion, anemia is associated with a rapid decrease in kidney function in patients with heart failure, particularly in those with underlying CKD...

..66) for all-cause mortality. Anemia was not a risk factor for any outcome in those without CKD (P > 0.2 for all outcomes). In persons with diabetes, anemia is primarily a risk factor for adverse outcomes in those who also have CKD...

..We examined the effect of a very low-protein diet on the development of kidney failure and death during long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study...

..High CRP, but not serum albumin, is a risk factor for cardiovascular mortality. These results suggest that high CRP and hypoalbuminemia provide prognostic information independent of each other in CKD...

..There is insufficient evidence to suggest that low tHcy is associated with poor nutritional status in the MDRD Study cohort. B vitamins and GFR, but not dietary protein, are the major determinants of tHcy in this patient population...

..This dimethylated amino acid accumulates in chronic kidney disease and may be involved in the pathophysiology of cardiovascular disease (CVD) in this population...

..In cross-sectional analyses, C-reactive protein (CRP) levels are inversely related to levels of kidney function. The relationship between kidney function and subsequent changes in CRP is unknown...

..A linear model best described the relationship between GFR and CVD. CONCLUSION: The level of GFR is an independent risk factor for CVD, de novo CVD, and all-cause mortality in the elderly...

..For a full list of participating Cardiovascular Health Study investigators and institutions, see http://www.chs-nhlbi.org...

..We hypothesized that kidney dysfunction would predict diastolic HF (DHF) better than systolic HF (SHF) in the Cardiovascular Health Study...

..This study sought to determine the association of chronic kidney disease (CKD) with high ankle brachial index (ABI) measurement and to compare its strength with that of CKD with a low ABI...

..The objective of this study was to determine whether elevated markers of inflammation are independently associated with longitudinal kidney function decline...

..Chronic kidney disease is a risk factor for cardiovascular disease (CVD); however, it is uncertain if CVD is a risk factor for progression or development of kidney disease...

..We evaluated the associations of apolipoprotein E alleles with kidney function among older adults in the cardiovascular health study (CHS)...

..The study objective was to identify predictors associated with various causes of death in the Hemodialysis (HEMO) Study and to develop a prediction model for SCD using a competing risk approach...

..CONCLUSION: The efficacy of a 2- to 3-year intervention of dietary protein restriction on progression of nondiabetic kidney disease remains inconclusive. Future studies should include a longer duration of intervention and follow-up...

..Associations seemed stronger for participants with CKD; however, no significant interactions were detected. Resting electrocardiographic abnormalities are common in CKD and independently predict future clinical CV events in this setting...

..Data are limited on the relationship of BMI with mortality in patients in the earlier stages of chronic kidney disease (CKD)...

..CONCLUSION: The presence of CKD in a community-based population with preexisting CVD is associated with an increased risk for recurrent CVD outcomes. This increased risk persists after adjustment for traditional CVD risk factors...

..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...

..15 [95% CI, 2.62 to 6.56] and 3.92 [95% CI, 2.05 to 7.48]; P = 0.02 and 0.01 for interaction term, respectively). The combination of anemia and LVH in CKD identifies a high-risk population...

..A low serum bicarbonate level is prevalent in chronic kidney disease (CKD); however, its relationship to long-term outcomes is unclear...

..It remains unknown, however, whether longitudinal declines in kidney function are independently associated with increased cardiovascular and all-cause mortality in older adults...

..It is unknown whether defining chronic kidney disease (CKD) based on one versus two estimated glomerular filtration rate (eGFR) assessments changes the prognostic importance of reduced eGFR in a community-based population...

..Alcohol consumption appears to be protective for cardiovascular disease; however, its relationship with kidney disease is unclear...

..Dyslipidemia confers a paradoxical survival advantage in patients with kidney failure. Data are limited in the earlier stages of chronic kidney disease (CKD)...

..Visceral (VAT) and subcutaneous adipose tissue (SAT) may confer differential metabolic risk profiles. The relations of VAT and SAT were analyzed with CKD as estimated by creatinine- and cystatin-based estimating equations...

..CKD and elevated SBP are independent risk factors for incident stroke. In CKD, individuals with the lowest BP are at increased risk for stroke. This pattern is not seen in the general population...

..The impact of dialysis dose on cognitive function remains uncertain, particularly in the current era of increased dialysis dose and flux...

..Concurrently, CVD may promote CKD, resulting in a vicious cycle. We evaluated this hypothesis by exploring whether CKD and CVD have an additive or synergistic effect on future cardiovascular and mortality outcomes...

..Further studies are necessary to confirm this association and to elucidate the underlying mechanisms...

..Moderate kidney disease may predispose to infection. We sought to determine whether decreased kidney function, estimated by serum cystatin C level, was associated with the risk of infection-related hospitalization in older individuals...

..trace protein and cystatin C seem to provide more consistent prognostic information than creatinine...

..The growing burden and morbidity of chronic kidney disease (CKD) warrant effective strategies for identifying those at increased risk. We examined the association of cystatin C level and albuminuria with the development of CKD stage 3...

..In vitro and in vivo data suggest that markers of inflammation and nutritional status may be risk factors for the progression of chronic kidney disease...

..13) for ASCVD, de novo ASCVD, and recurrent ASCVD, respectively. A nonlinear model did not fit the data better than a linear model. CONCLUSIONS: The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study...

..Although the efficacy of β-blockers for the prevention of sudden cardiac death has been proven in the general population, little evidence exists in patients with kidney failure...

..We therefore explored whether serum cystatin C level is associated with carotid intima-media thickness (IMT) in ambulatory adults without clinical heart disease...

..Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown...

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..Several more interventional trials are ongoing, but the available data thus far do not support screening for or treatment of hyperhomocysteinemia...

..The Framingham equations were developed to predict incident coronary heart disease. It remains unknown how the presence of chronic kidney disease affects their performance...

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..Studies have questioned, however, whether cystatin C is predominantly a measure of kidney function. This review summarizes the research literature on cystatin C...

..These results suggest that, despite relatively normal MMSE scores, mild cognitive impairment may be prevalent in hemodialysis patients. The pattern of cognitive dysfunction is primarily subcortical in nature...

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..The clinical importance of these findings remains unknown...

..These studies show that body composition in end-stage renal disease bears a complex relationship to all-cause mortality...

..Albuminuria, a kidney marker of microvascular disease, may herald microvascular disease elsewhere, including in the brain...

..SUMMARY: Cystatin C shows promise as an alternative to serum creatinine but several important questions remain before it can be recommended for use in clinical practice...

..We explore potential measures to reduce cognitive impairment in this population. We conclude that additional research is needed in this area...

..Elevated total homocysteine (tHcy) levels and low B vitamin levels are risk factors for atherosclerosis, but have not been evaluated sufficiently as risk factors for the progression of kidney disease...

..There are 3 ongoing randomized controlled trials that are assessing the effect of statin therapy on CVD outcomes. These studies will hopefully provide definitive answers as to the appropriate treatment of dyslipidemia in CKD...

..Given the high prevalence of cognitive impairment in all stages of CKD, additional studies are needed to evaluate potential risk factors and treatments in this vulnerable population...

..Treatment recommendations are provided using evidence available from populations with CKD or evidence extrapolated from the general population when there are insufficient data on individuals with CKD...

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..We investigated whether the presence of anemia is a risk factor for cardiovascular disease (CVD) outcomes in the general population...

..We conclude that additional epidemiologic, basic science, and interventional studies are needed to further elucidate the prevalence, prognostic importance, pathophysiology, and potential treatment of intradialytic hypertension...

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..Rate of decline in kidney function is a strong predictor of increased mortality in this population, independent of worsening heart failure and baseline kidney function...

..We compared cystatin-C, a novel marker of renal function, with creatinine and estimated glomerular filtration rate (eGFR) as predictors of C-reactive protein and fibrinogen levels...

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..We sought to evaluate cystatin-C, a novel measure of renal function, as a predictor of mortality in elderly persons with heart failure (HF) and to compare it with creatinine...

..Uric acid levels are increased in patients with kidney dysfunction. We tested the hypothesis that uric acid may be associated with kidney disease progression...

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..Kidney function predicts noncardiovascular mortality from multiple causes in the elderly. Further research is needed to understand the mechanisms and evaluate interventions to reduce the high mortality rate in chronic kidney disease...

..We compared creatinine and cystatin C levels as predictors of mortality from cardiovascular causes and from all causes in the Cardiovascular Health Study, a cohort study of elderly persons living in the community...

..Mildly to moderately decreased kidney function is far more common and also is associated with an elevated prevalence of anemia and CHD risk. Recent data suggest an even higher risk of CHD when both conditions are present...

..The proposed L training program and research project will prepare him for a career as an independent investigator. ..

..Evaluating the importance of traditional and non-traditional risk factors in CKD is essential in that it will focus attention on the most important cardiac risk factors in this population. ..

..Evaluating the prevalence of, as well as potential risk factors for, cognitive impairment may lead to intervention trials to reduce the burden of cognitive impairment in this patient population. ..

..Training future investigators in POR will be essential to reduce the burden of CKD in the future. ..