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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiovascular risk factor treatment targets and renal complications in high risk vascular patients: a cohort study
Sharmini Selvarajah1, Yolanda van der Graaf, Frank L J Visseren
1Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. s.selvarajah@umcutrecht.nl
Insights
Adhering to cardiovascular disease management guidelines significantly lowers renal complication risks in high-risk patients. Achieving any two treatment targets, such as blood pressure and cholesterol control, demonstrates substantial benefits.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Clinical Research
Background:
- Cardiovascular disease (CVD) management guidelines aim to mitigate risks in high-risk populations.
- Renal complications are a significant concern for patients with CVD.
Purpose of the Study:
- To evaluate if adhering to CVD treatment targets reduces renal complications.
- To assess the impact of achieving specific targets on renal health outcomes.
Main Methods:
- A cohort study of 7,208 participants in Utrecht, Netherlands, with or at risk of CVD.
- Key targets included blood pressure, cholesterol (total and LDL), and albuminuria control.
- Outcomes measured were end-stage renal failure and renal atherosclerotic disease requiring intervention.
Main Results:
- 29-39% achieved blood pressure targets, 28-31% achieved cholesterol targets, and 78% achieved albuminuria targets.
- Linear reduction in renal failure and disease incidence with each additional target met (p<0.001).
- Achieving any two targets reduced renal complication risk (HR 0.46); this effect was pronounced in diabetic patients (HR 0.28).
Conclusions:
- Clinical guidelines for CVD management effectively reduce renal complication risk in high-risk individuals.
- Attaining at least two treatment targets is associated with significant renal protection.
Background:
To determine if recommended treatment targets, as specified in clinical practice guidelines for the management of cardiovascular disease, reduces the risk of renal complications in high risk patient populations.
Methods:
This was a cohort study. Participants in Utrecht, The Netherlands either at risk of, or had cardiovascular disease were recruited. Cardiovascular treatment targets were achievement of control in systolic and diastolic blood pressure, total and low-density cholesterol, and treatment of albuminuria. Outcome measures were time to development of end stage renal failure or symptomatic renal atherosclerotic disease requiring intervention.
Results:
The cohort consisted of 7,208 participants; 1,759 diabetics and 4,859 with clinically manifest vascular disease. The median age was 57 years and 67% were male. Overall, 29% of the cohort achieved the treatment target for systolic blood pressure, 39% for diastolic blood pressure, 28% for total cholesterol, 31% for LDL cholesterol and 78% for albuminuria. The incidence rate for end stage renal failure and renal atherosclerotic disease reduced linearly with each additional treatment target achieved (p value less than 0.001). Achievement of any two treatment targets reduced the risk of renal complications, hazard ratio 0.46 (95% CI 0.26-0.82). For patients with clinically manifest vascular disease and diabetes, the hazard ratios were 0.56 (95% CI 0.28 - 1.12) and 0.28 (95%CI 0.10 - 0.79) respectively.
Conclusion:
Clinical guidelines for cardiovascular disease management do reduce risk of renal complications in high risk patients. Benefits are seen with attainment of any two treatment targets.
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