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Updated: Dec 12, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiovascular Determinants of Mortality in Advanced Chronic Kidney Disease
Roosa Lankinen1, Markus Hakamäki2, Kaj Metsärinne1
1Kidney Center, Turku University Hospital and University of Turku, Turku, Finland.
Insights
Advanced chronic kidney disease (CKD) patients face high mortality. Key predictors include cardiac biomarkers, exercise capacity, aortic calcification, and albumin levels, guiding risk assessment in CKD stage 4-5.
Area of Science:
- Nephrology
- Cardiology
- Gerontology
Background:
- Patients with advanced chronic kidney disease (CKD stage 4-5) exhibit elevated mortality risk.
- The Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study enrolled 210 non-dialysis CKD stage 4-5 patients.
- This study aimed to identify factors contributing to all-cause mortality in this high-risk population.
Purpose of the Study:
- To investigate the determinants of all-cause mortality in patients with advanced chronic kidney disease (CKD stage 4-5).
- To identify clinical and subclinical markers associated with increased mortality risk in non-dialysis CKD patients.
Main Methods:
- Prospective study including 210 CKD stage 4-5 patients.
- Maximal bicycle ergometry stress testing and lateral lumbar radiography for abdominal aortic calcification score.
- Echocardiography and arterial stiffness measurements (intima-media thickness, elasticity, flow-mediated dilatation).
Main Results:
- Follow-up duration averaged 42 months; 21% of patients died.
- Significant mortality predictors identified include troponin T, N-terminal pro-B-type natriuretic peptide, ergometry performance, abdominal aortic calcification score, E/e' ratio, and albumin.
- Most patients had hypertension, diabetes, or coronary artery disease.
Conclusions:
- Maximal stress ergometry performance, abdominal aortic calcification score, echocardiographic E/e' ratio, plasma cardiac biomarkers, and albumin are significant predictors of mortality in advanced CKD.
- These findings highlight the multifactorial nature of mortality in advanced CKD and suggest targets for risk stratification and intervention.
Background:
Patients with advanced chronic kidney disease (CKD stage 4-5) have an increased risk of death. To study the determinants of all-cause mortality, we recruited 210 consecutive CKD stage 4-5 patients not on dialysis to the prospective Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury (CADKID) study.
Methods:
One hundred seventy-four patients underwent maximal bicycle ergometry stress testing and lateral lumbar radiography to study abdominal aortic calcification score and echocardiography. Carotid and femoral artery intima-media thickness and elasticity and brachial artery flow-mediated dilatation were measured in 156 patients.
Results:
The duration of follow-up was 42 ± 17 months (range 134-2,217 days). The mean age was 61 ± 14 years, and the estimated glomerular filtration rate was 12 (11-15) mL/min/1.73 m2. Thirty-six (21%) patients died during follow-up (time to death 835 ± 372 days). Seventy-five and 21 patients had diabetes and coronary artery disease, respectively, and all but one had hypertension. In the respective multivariate proportional hazards models adjusted for age, sex, and coronary artery disease, the significant determinants of mortality were troponin T, N-terminal pro-B-type natriuretic peptide, maximal ergometry performance, abdominal aortic calcification score, E/e' ratio, and albumin.
Conclusion:
Stress ergometry performance, abdominal aortic calcification score, E/e' of echocardiography, and plasma cardiac biomarkers and albumin predict mortality in advanced CKD.
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