Abstract
The high prevalence of cardiovascular disease in patients with kidney disease is well described. This Canadian, multi-centre, observational cohort study reports the prevalence and risk factors of CVD associated with kidney disease in a cohort of patients with established chronic kidney disease (CKD) who are followed by nephrologists. This analysis sought to answer 2 questions:
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(1)
in patients with established CKD, are the prevalence and progression of CVD accounted for by conventional or uremia related risk factors?
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(2)
to what extent can progression to RRT be explained by CVD versus ‘traditional risk factors’ for kidney disease?
This study population consists of 313, predominantly male patients who had a mean age of 56 years and a mean creatinine clearance of 36 ml/min. Thirty percent were diabetic. The overall prevalence of CVD was 46% and was independent of severity of kidney dysfunction (p=0.700). The median follow up time was 23 months, for a total of 462 patient years. We note the overall incidence of CVD events (new CVD or worsening of CVD) was 47/244 (20%). The best predictors of new CVD events among those without pre-existing CVD were diabetes (OR=5.35, p=0.018) and age (OR= 1.26, p=0.08). In those with pre-existing CVD, low DP (OR=0.72, p=0.004) and high triglycerides (OR=1.48, p=0.019) at baseline were independent predictors of progression of CVD. We could not determine an independent impact of kidney function on CVD in the overall cohort. Furthermore, we determined that the presence of CVD itself confers an increased risk of progression to RRT (RR= 1.58, p=0.047), adjusted for kidney function.
This is the first in-depth analysis of CVD in a cohort of patients with established chronic kidney disease who are not on dialysis. The question regarding the impact of the altered biology of uremia in contributing to CVD progression remains unanswered and clearly needs further study. However, the findings do raise the issue of whether aggressive treatment of CVD and risk factors might, in fact, reduce progression to RRT. Further large scale observational studies as well as interventional studies are needed to more clearly understand the complex biology of cardiovascular and kidney disease progression.
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Levin, A. et al. (2002). Cardiovascular Disease in Patients with Chronic Kidney Disease: The Causes and Effects. In: Avram, M.M. (eds) Improving Prognosis for Kidney Disorders. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-1848-6_3
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DOI: https://doi.org/10.1007/978-94-017-1848-6_3
Publisher Name: Springer, Dordrecht
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