Abstract
Background
The risks and subsequent outcomes of syncope among seniors with chronic kidney disease
(CKD) are unclear.
Methods
We conducted a population-based retrospective cohort study of 272,146 patients ≥ 66
years old, in Ontario, Canada, from April 1, 2006, to March 31, 2016. Using administrative
health care databases, we examined the association of estimated glomerular filtration
rate (eGFR) and urine albumin to creatinine ratio (ACR) with incident syncope and
the association of incident syncope with the composite outcome of myocardial infarction,
stroke, and death by levels of eGFR/ACR, using adjusted Cox proportional hazards models.
Results
A total of 15,074 incident syncopal events occurred during the study period. The adjusted
risk for syncope was higher with a lower eGFR and higher ACR in a stepwise manner
(eGFR 60 to < 90: HR 1.17 [1.09-1.26] vs eGFR < 30: HR 1.67 (1.50-1.87) with eGFR
≥ 90 referent; ACR > 30: HR 1.15 [1.07-1.24] with ACR < 3 referent). Among the 12,710
patients with a first syncope event and 1 year of follow-up, the adjusted risk for
the composite outcome was higher with a lower eGFR and higher ACR in a stepwise manner
(eGFR 60 to < 90: HR 1.05 [0.90-1.22] vs eGFR < 30: HR 1.62 [1.34-1.96] with eGFR
≥ 90 referent; ACR > 30: HR 1.77 [1.60-1.96], ACR < 3 referent).
Conclusions
A lower eGFR and higher ACR are associated with a higher risk of a hospital encounter
for syncope and of related complications among persons of advanced age.
Résumé
Introduction
On en connaît peu sur les risques et les issues de la syncope chez les personnes âgées
atteintes d’une maladie rénale chronique.
Méthodes
Nous avons mené une étude de cohorte rétrospective en population générale auprès de
272 146 patients ≥ 66 ans, en Ontario, au Canada, du 1er avril 2006 au 31 mars 2016. À l’aide des banques de données administratives sur les
soins de santé, nous avons examiné l’association du taux de filtration glomérulaire
estimé (TFGe) et du ratio albumine/créatinine (RAC) dans l’urine aux nouveaux cas
de syncope, et l’association des nouveaux cas de syncope au critère composite d’infarctus
du myocarde, d’accident vasculaire cérébral et de décès en fonction des taux de TFGe/RAC
à l’aide des modèles à risques proportionnels de Cox ajustés.
Résultats
Un total de 15 074 nouveaux événements syncopaux sont survenus durant la période étudiée.
Le risque ajusté de syncope était plus élevé lorsque le TFGe était plus faible et
le RAC, plus élevé selon l’approche progressive (TFGe 60 à < 90 : RIA 1,17 [1,09-1,26]
vs TFGe < 30 : RIA 1,67 [1,50-1,87] avec un TFGe ≥ valeur de référence de 90; RAC >
30 : RIA 1,15 [1,07-1,24] avec RAC < valeur de référence de 3). Parmi les 12 710 patients
ayant subi une première syncope et ayant 1 an de suivi, le risque ajusté de critère
combiné était plus élevé avec un TFGe plus faible et un RAC plus élevé selon l’approche
progressive (TFGe de 60 à < 90 : RIA 1,05 [0,90-1,22] vs TFGe < 30 : RIA 1,62 [1,34-1,96] avec un TFGe ≥ valeur de référence de 90; RAC >
30 : RIA 1,77 [1,60-1,96], RAC < valeur de référence de 3).
Conclusions
Un TFGe plus faible et un RAC plus élevé sont associés à un risque plus élevé de visites
à l’hôpital pour une syncope et des complications associées chez les personnes d’un
âge avancé.
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Article info
Publication history
Published online: August 28, 2018
Accepted:
August 23,
2018
Received:
May 29,
2018
Footnotes
See page 1639 for disclosure information.
M.M.S., D.M-A., M.K.M., and J.P.K. contributed to the study design and review of the manuscript. D.M-A. and M.M.S. drafted the first version of the manuscript. J.P.K. conducted the data analysis. All authors read, critiqued, contributed to, and approved the final manuscript.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
