Related Experiment Video
Updated: Jul 16, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Impaired Renal Function and Major Cardiovascular Events in Young Adults
Junayd Hussain1, Haris Imsirovic2, Mark Canney3
1School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada.
Insights
Subclinical reductions in kidney function, indicated by estimated glomerular filtration rate (eGFR) below age-expected values, increase cardiovascular disease risk in young adults. Early detection and intervention are crucial for managing this rising health concern.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CV) is increasing among young adults (18-39 years).
- The association between subclinical kidney function decline (eGFR below age-expected values) and elevated CV risk in this demographic remains unclear.
- Subclinical kidney function reduction is defined as estimated glomerular filtration rate (eGFR) above the chronic kidney disease threshold but below age-expected levels.
Purpose of the Study:
- To investigate the age-specific relationship between subclinical reductions in eGFR and major adverse cardiovascular events (MACE) in young adults.
- To examine the association between subclinical eGFR reductions and MACE plus heart failure (MACE+).
Main Methods:
- Retrospective cohort study involving 8.7 million individuals, with 3.6 million aged 18-39 years, using Canadian provincial health data (2008-2021).
- Cox models analyzed the association of categorized eGFR (50-120 mL/min/1.73 m²) with MACE and MACE+.
- Analyses were stratified by age groups: 18-39, 40-49, and 50-65 years.
Main Results:
- A stepwise increase in MACE and MACE+ risk was observed starting with eGFR < 80 mL/min/1.73 m² in young adults.
- For MACE, the hazard ratio (HR) was 1.31 (95% CI: 1.27-1.40) for ages 18-30 with eGFR 70-79 mL/min/1.73 m².
- These associations remained consistent across MACE components and in sensitivity analyses, including those accounting for prior CV disease, albuminuria, and repeated eGFR measures.
Conclusions:
- Subclinical reductions in eGFR below age-expected levels are linked to increased MACE and MACE+ risk in young adults.
- Age-appropriate risk stratification is necessary for young adults with reduced kidney function.
- Proactive monitoring and timely intervention strategies should be considered for this population.
Background:
Cardiovascular (CV) disease in young adults (aged 18-39 years) is on the rise. Whether subclinical reductions in kidney function (ie, estimated glomerular filtration rate [eGFR] above the current threshold for chronic kidney disease but below age-expected values) are associated with elevated CV risk is unknown.
Objectives:
The goal of this study was to examine age-specific associations of subclinical eGFR reductions in young adults with major adverse cardiovascular events (MACEs) and MACE plus heart failure (MACE+).
Methods:
A retrospective cohort study of 8.7 million individuals (3.6 million aged 18-39 years) was constructed using linked provincial health care data sets from Ontario, Canada (January 2008-March 2021). Cox models were used to examine the association of categorized eGFR (50-120 mL/min/1.73 m2) with MACE (first of CV mortality, acute coronary syndrome, and ischemic stroke) and MACE+, stratified according to age (18-39, 40-49, and 50-65 years).
Results:
In the study cohort (mean age 41.3 years; mean eGFR 104.2 mL/min/1.73 m2; median follow-up 9.2 years), a stepwise increase in the relative risk of MACE and MACE+ was observed as early as eGFR <80 mL/min/1.73 m2 in young adults (eg, for MACE, at eGFR 70-79 mL/min/1.73 m2, ages 18-30 years: 2.37 events per 1,000 person years [HR: 1.31; 95% CI: 1.27-1.40]; ages 40-49 years: 6.26 events per 1,000 person years [HR: 1.09; 95% CI: 1.06-1.12]; ages 50-65 years: 14.9 events per 1,000 person years [HR: 1.07; 95% CI: 1.05-1.08]). Results persisted for each MACE component and in additional analyses (stratifying according to past CV disease, accounting for albuminuria at index, and using repeated eGFR measures).
Conclusions:
In young adults, eGFR below age-expected values were associated with an elevated risk for MACE and MACE+, warranting age-appropriate risk stratification, proactive monitoring, and timely intervention.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:24Chronic Kidney Disease II: Clinical Manifestations
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention