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Updated: Jun 26, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Five-Year Cumulative Cardiovascular Health and Clinical Events in Patients With Chronic Kidney Disease: The CRIC
Qiuyu Cao1,2,3, Yufang Bi1,2, Flor Alvarado4,5
1Department of Endocrine and Metabolic Diseases Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China.
Insights
Maintaining higher cardiovascular health (CVH) in chronic kidney disease (CKD) patients over five years lowers risks of cardiovascular disease (CVD), end-stage kidney disease (ESKD), and death. This highlights the importance of CVH for CKD patient outcomes.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Cardiovascular health (CVH) is linked to better outcomes in the general population.
- Its impact on cardiovascular disease (CVD), end-stage kidney disease (ESKD), and mortality in chronic kidney disease (CKD) patients remains unclear.
Purpose of the Study:
- To investigate the association between cumulative cardiovascular health (CVH) score and risks of CVD, ESKD, and all-cause mortality in CKD patients.
- To determine if maintaining a better CVH status over time impacts adverse outcomes in this population.
Main Methods:
- Utilized data from the prospective CRIC (Chronic Renal Insufficiency Cohort) Study.
- Calculated cumulative CVH score based on the percentage of maximum possible score from baseline to year 5.
- Employed multivariable-adjusted Cox proportional hazards regression to analyze associations with CVD, ESKD, and mortality over a median 10.2-year follow-up.
Main Results:
- Included 3939 CKD patients (mean age 57.7 years).
- Mean cumulative CVH score over 5 years was 55.5%.
- Higher cumulative CVH score was significantly associated with lower risks of CVD (HR 0.81 per 10% increase), ESKD (HR 0.82), and mortality (HR 0.80), independent of year 5 CVH score.
Conclusions:
- Better CVH status maintained over 5 years is linked to reduced risks of CVD, ESKD, and death in CKD stages 2-4 patients.
- Findings underscore the importance of interventions aimed at improving and maintaining ideal CVH in CKD populations.
- Promoting CVH can be a strategy for preventing adverse outcomes in individuals with chronic kidney disease.
Background:
Higher cardiovascular health (CVH) score is associated with lower risks of cardiovascular disease (CVD) and mortality in the general population. However, it is unclear whether cumulative CVH is associated with CVD, end-stage kidney disease (ESKD), and death in patients with chronic kidney disease.
Methods And Results:
Among individuals from the prospective CRIC (Chronic Renal Insufficiency Cohort) Study, we used the percentage of the maximum possible CVH score attained from baseline to the year 5 visit to calculate cumulative CVH score. Multivariable-adjusted Cox proportional hazards regression was used to investigate the associations of cumulative CVH with risks of adjudicated CVD (myocardial infarction, stroke, and heart failure), ESKD, and all-cause mortality. A total of 3939 participants (mean age, 57.7 years; 54.9% men) were included. The mean (SD) cumulative CVH score attained during 5 years was 55.5% (12.3%). Over a subsequent median 10.2-year follow-up, 597 participants developed CVD, 656 had ESKD, and 1324 died. A higher cumulative CVH score was significantly associated with lower risks of CVD, ESKD, and mortality, independent of the CVH score at year 5. Multivariable-adjusted hazard ratios and 95% CIs per 10% higher cumulative CVH score during 5 years were 0.81 (0.69-0.95) for CVD, 0.82 (0.70-0.97) for ESKD, and 0.80 (0.72-0.89) for mortality.
Conclusions:
Among patients with chronic kidney disease stages 2 to 4, a better CVH status maintained throughout 5 years is associated with lower risks of CVD, ESKD, and all-cause mortality. The findings support the need for interventions to maintain ideal CVH status for prevention of adverse outcomes in the population with chronic kidney disease.
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