Published Online
on July 10, 2008

A more recent version of this article appeared on October 1, 2008

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Submitted on January 7, 2008
Accepted on January 17, 2008

The Association Between Kidney Disease and Cardiovascular Risk in a Multiethnic Cohort. Findings From the Northern Manhattan Study (NOMAS)

Thomas L. Nickolas MD, MS^*; Minesh Khatri MD; Bernadette Boden-Albala DrPH; Krzysztof Kiryluk MD; Xiaodong Luo PhD; Palma Gervasi-Franklin BA; Myunghee Paik PhD; and Ralph L. Sacco MD, MS

From Department of Medicine (T.L.N., K.K.), Department of Neurology (B.B.A., M.K., R.L.S., X.L., P.G.F.), Department of Sociomedical Science (B.B.A.), Department of Biostatistics (X.L., M.C.P.), College of Physicians and Surgeons, and the Mailman School of Public Health, Columbia University, New York, NY; and the Departments of Neurology and Epidemiology (R.L.S.), Miller School of Medicine, University of Miami, Fla.

^* To whom correspondence should be addressed. E-mail: tln2001{at}columbia.edu.

Background and Purpose—The objective of this study was to determine the relationship between chronic kidney disease (CKD), race–ethnicity, and vascular outcomes.

Methods—A prospective, multiracial cohort of 3298 stroke-free subjects with 6.5 years of mean follow-up time for vascular outcomes (stroke, myocardial infarction, vascular death) was used. Kidney function was estimated using serum creatinine and Cockcroft-Gault formula. Cox proportional hazards models were fitted to evaluate the relationship between kidney function and vascular outcomes.

Results—In multivariate analysis, Cockcroft-Gault formula between 15 and 59 mL/min was associated with a significant 43% increased stroke risk in the overall cohort. Blacks with Cockcroft-Gault formula between 15 and 59 mL/min had significantly increased risk of both stroke (hazard ratio, 2.65; 95% CI, 1.47 to 4.77) and combined vascular outcomes (hazard ratio, 1.59; 95% CI, 1.10–2.92).

Conclusion—Chronic kidney disease is a significant risk factor for stroke and combined vascular events, especially in blacks.

Key words: cardiac • chronic kidney disease • epidemiology • outcome • risk factors • stroke

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