Cardiovascular risk is similar in patients with glomerulonephritis compared to other types of chronic kidney disease: a matched cohort study
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Published on: July 3, 2013
Holly L Hutton1,2, Adeera Levin3,4,5, Jagbir Gill3,5
1Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia. holly.hutton@monash.edu.
Insights
Patients with chronic kidney disease (CKD) from glomerulonephritis (GN) face high cardiovascular disease (CVD) risk, primarily due to existing risk factors and kidney function, not GN itself.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Patients with chronic kidney disease (CKD) due to glomerulonephritis (GN) are presumed to have a high risk of cardiovascular disease (CVD).
- Previous research has not determined if GN independently contributes to CVD risk beyond established risk factors and renal function.
- This study investigates the direct impact of GN on cardiovascular risk in CKD patients.
Purpose of the Study:
- To determine if glomerulonephritis (GN) independently increases cardiovascular disease (CVD) risk in patients with advanced chronic kidney disease (CKD).
- To differentiate the contribution of GN versus traditional risk factors and renal function to CVD events in CKD.
Main Methods:
- A matched cohort study utilized data from the prospective CanPREDDICT study, including 2187 CKD patients (eGFR 15-45 ml/min/m²).
- Patients were categorized into GN and non-GN groups, excluding those on immunotherapy.
- Cardiovascular risk factors, biomarkers, and outcomes were assessed over 3 years, with the primary endpoint being the first all-cause CV event.
Main Results:
- Initially, the GN group had a lower incidence of CV events (8.7%) compared to the non-GN group (17.8%).
- After multivariable adjustment for age, sex, diabetes, prior CVD, baseline eGFR, and renal replacement therapy, the risk of CV events was similar between GN and non-GN groups (HR 0.71).
- In a propensity score-matched analysis, the risk of CV events remained comparable between GN and non-GN patients (HR 1.01), indicating GN itself does not confer additional risk.
Conclusions:
- Patients with advanced CKD due to GN exhibit a significant 3-year CVD risk (8.7%).
- This elevated risk is primarily attributed to pre-existing cardiovascular risk factors and the degree of kidney function impairment.
- The glomerulonephritis disease process itself does not appear to be an independent driver of cardiovascular risk in this advanced CKD population.
Background:
Patients with chronic kidney disease (CKD) due to glomerulonephritis (GN) are thought to be at high risk for cardiovascular disease (CVD). However, no study has examined whether GN directly contributes to CV risk beyond the effects conferred by pre-existing traditional risk factors and level of renal function.
Methods:
Matched cohort study using the previously described prospective CanPREDDICT study cohort. 2187 patients with CKD (eGFR 15-45 ml/min/m2) from 25 Canadian centres were divided into GN vs non-GN cause of CKD. Patients on immunotherapy for GN were not included in the study. Standardized measures of CV risk factors, biomarkers and CV outcomes were recorded over 3 years of follow-up, with the primary outcome measure being time to first all-cause CV event.
Results:
In the overall cohort, CV events occurred in 25 (8.7%) of the GN group and 338 (17.8%) of the non-GN group (HR 0.45, 95% CI 0.30-0.67, p < 0.01). In a Cox regression multivariable model that included age, sex, prior diabetes and CVD, baseline eGFR and onset of renal replacement therapy, the risk of CV events was similar in the GN and non-GN groups (HR 0.71, 95% CI 0.47-1.08, p = 0.11). GN and non-GN patients were matched by age and using a propensity score including sex, prior diabetes and CVD and baseline eGFR. In the matched group, the risk of CV events was similar in GN vs non-GN patients (N = 25/271 (9.2%) in both groups, HR 1.01, 95% CI 0.05-1.77, p = 0.9). An interaction analysis showed that CRP, ACR and troponin conferred differing amounts of CV risk in the GN and non-GN groups.
Conclusions:
Patients with advanced CKD due to GN have a high 8.7% absolute 3-year risk of CVD, attributable to prior CV risk factors and level of kidney function rather than the GN disease itself.
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