Supplementary Material for: Relationship between Stage of Kidney Disease and Incident Heart Failure in Older Adults

Background: The relationship between stage of chronic kidney disease (CKD) and incident heart failure (HF) remains unclear. Methods: Of the 5,795 community-dwelling adults ≧65 years in the Cardiovascular Health Study, 5,450 were free of prevalent HF and had baseline estimated glomerular filtration rate (eGFR: ml/min/1.73 m²) data. Of these, 898 (16%) had CKD 3A (eGFR 45–59 ml/min/1.73 m²) and 242 (4%) had CKD stage ≧3B (eGFR <45 ml/min/1.73 m²). Data on baseline proteinuria were not available and 4,310 (79%) individuals with eGFR ≧60 ml/min/1.73 m² were considered to have no CKD. Propensity scores estimated separately for CKD 3A and ≧3B were used to assemble two cohorts of 1,714 (857 pairs with CKD 3A and no CKD) and 557 participants (148 CKD ≧3B and 409 no CKD), respectively, balanced on 50 baseline characteristics. Results: During 13 years of follow-up, centrally-adjudicated incident HF occurred in 19, 24 and 38% of pre-match participants without CKD (reference), with CKD 3A [unadjusted hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.20–1.63; p < 0.001] and with CKD ≧3B (HR 3.37; 95% CI 2.71–4.18; p < 0.001), respectively. In contrast, among matched participants, incident HF occurred in 23 and 23% of those with CKD 3A and no CKD, respectively (HR 1.03; 95% CI 0.85–1.26; p = 0.746), and 36 and 28% of those with CKD ≧3B and no CKD, respectively (HR 1.44; 95% CI 1.04–2.00; p = 0.027). Conclusions: Among community-dwelling older adults, CKD is a marker of incident HF regardless of stage; however, CKD ≧3B, not CKD 3A, has a modest independent association with incident HF.