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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD
Daniel E Weiner1, Hocine Tighiouart, Essam F Elsayed
1Division of Nephrology, Tufts-New England Medical Center, Boston, MA 02111, USA. dweiner@tufts-nemc.org
Insights
Nontraditional risk factors like low albumin and high fibrinogen predict cardiovascular events and mortality in chronic kidney disease patients. The relationships are often nonlinear, highlighting complex disease interactions.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Chronic kidney disease (CKD) significantly elevates the risk of cardiovascular disease (CVD) and mortality.
- Both established and novel CVD risk factors contribute to adverse outcomes in CKD patients.
Purpose of the Study:
- To investigate the association between nontraditional cardiovascular disease risk factors and adverse outcomes in individuals with reduced estimated glomerular filtration rate (eGFR).
- To identify specific nontraditional risk factors that predict composite cardiovascular events and mortality in a community-based CKD population.
Main Methods:
- A cohort study utilizing data from the Atherosclerosis Risk in Communities and Cardiovascular Health Studies.
- Included community-based adults with an eGFR less than 60 mL/min/1.73 m(2).
- Assessed nontraditional risk factors including BMI, blood pressure, triglycerides, albumin, uric acid, fibrinogen, C-reactive protein, and hemoglobin levels.
Main Results:
- In 1,678 individuals with decreased eGFR, 53% experienced a composite endpoint (myocardial infarction, stroke, or all-cause mortality) over 108 months.
- Low serum albumin, high triglycerides, high C-reactive protein, and high fibrinogen independently predicted composite events.
- Both low and high hemoglobin levels, and nonlinear relationships for albumin and hemoglobin with outcomes, were observed.
Conclusions:
- Nontraditional cardiovascular disease risk factors are significant predictors of adverse outcomes in individuals with stage 3 to 4 CKD.
- The complex, often nonlinear, relationships between these risk factors and outcomes underscore the need for comprehensive risk assessment in CKD.
- Limitations include a single eGFR assessment and lack of albuminuria data.
Background:
Chronic kidney disease is associated with increased risk for cardiovascular disease and mortality. Both traditional and nontraditional cardiovascular disease risk factors may contribute.
Study Design:
Cohort.
Settings & Participants:
Community-based adult population of the Atherosclerosis Risk in Communities and Cardiovascular Health Studies with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m(2).
Predictors:
Nontraditional cardiovascular disease risk factors, including body mass index, diastolic blood pressure, and triglyceride, albumin, uric acid, fibrinogen, C-reactive protein, and hemoglobin levels.
Outcomes:
Composite of myocardial infarction, stroke, and all-cause mortality. Secondary outcomes included individual components of the composite.
Results:
Of 1,678 individuals with decreased eGFR (mean, 51.1 +/- 8.5 mL/min/1.73 m(2)), 891 (53%) reached the composite end point during a median follow-up of 108 months; 23% had a cardiac event, 45% died, and 14% experienced a stroke. Serum albumin level less than 3.9 g/dL (hazard ratio, 0.68 for every 0.3-g/dL decrease; 95% confidence interval, 0.60 to 0.77), increased serum triglyceride level (hazard ratio, 1.07 for every 50-mg/dL increase; 95% confidence interval, 1.02 to 1.12), C-reactive protein level (hazard ratio, 1.15 per log-unit increase; 95% confidence interval, 1.07 to 1.24), and fibrinogen level (hazard ratio, 1.12 per 50-mg/dL increase; 95% confidence interval, 1.07 to 1.18) independently predicted composite events. Both decreased (<14.5 g/dL) and increased (>14.5 g/dL) hemoglobin levels predicted composite events. Serum albumin level less than 3.9 g/dL and increased serum fibrinogen level independently predicted cardiac events. For serum albumin and hemoglobin levels, the relationship with composite and mortality outcomes was nonlinear (P < 0.001).
Limitations:
Single assessment of eGFR. No albuminuria data.
Conclusions:
Several nontraditional cardiovascular disease risk factors predict adverse outcomes in individuals with stage 3 to 4 chronic kidney disease. The relationship between risk factors and outcomes is often nonlinear.
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