Emerging cardiovascular risk factors that account for a significant portion of attributable mortality risk in chronic...

Area of Science:

• Nephrology
• Cardiology
• Biochemistry

Background:

• Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease and mortality.
• Traditional cardiovascular risk factors do not fully explain the elevated mortality in CKD patients.

Purpose of the Study:

• To investigate the contribution of novel cardiovascular risk factors to the association between CKD and mortality.
• To identify specific biomarkers that may explain the excess mortality in CKD.

Main Methods:

• A cohort of 4,680 new patients from a preventive cardiology program (1996-2005) was analyzed.
• Estimated glomerular filtration rate (eGFR) was calculated using the MDRD method.
• Baseline levels of traditional and emerging cardiovascular risk factors, including homocysteine and fibrinogen, were assessed. All-cause mortality was tracked.

Main Results:

• CKD (eGFR ≤60 ml/min/1.73 m²) was strongly associated with mortality, independent of traditional risk factors.
• Homocysteine and fibrinogen levels significantly attenuated the CKD-mortality association, explaining 38% of the attributable risk.
• A significant interaction between homocysteine and eGFR was observed, with high homocysteine levels dramatically increasing mortality risk in CKD patients.

Conclusions:

• Homocysteine and fibrinogen are key factors contributing to the excess mortality risk in patients with chronic kidney disease.
• These novel risk factors explain a substantial portion of CKD-attributable mortality, suggesting their importance in risk stratification and management.
• Targeting homocysteine and fibrinogen may offer therapeutic avenues to reduce cardiovascular mortality in CKD.