Trends in Major Cardiovascular Events and Bleeding Among Patients With Advanced CKD: A Nationwide Swedish Study

Area of Science:

• Nephrology and Cardiovascular Research
• Epidemiology of Chronic Diseases
• Public Health and Patient Outcomes

Background:

• Patients with advanced chronic kidney disease (CKD) face elevated risks for cardiovascular and bleeding complications.
• Understanding temporal trends in these adverse events is crucial for effective patient management and public health initiatives.
• This study investigates these trends within a Swedish cohort of advanced CKD patients.

Purpose of the Study:

• To characterize the rates and trends of major adverse cardiovascular events (MACE) and bleeding events in advanced CKD patients in Sweden.
• To compare these event rates and trends with those observed in the general Swedish population.
• To identify potential disparities in event rates and trends based on sex.

Main Methods:

• A retrospective cohort study utilizing the Swedish Renal Registry from 2011 to 2021.
• Inclusion of patients with Stage G4 CKD, non-dialysis Stage G5 CKD (ND-CKD), hemodialysis, and peritoneal dialysis.
• Analysis involved Poisson models to estimate incidence rates and standardized incidence rate ratios compared to the general population.

Main Results:

• Advanced CKD patients exhibited significantly higher rates of MACE and bleeding events compared to the general population (1.4 to 13.6 times higher by 2021).
• Between 2011 and 2021, significant reductions were observed in MACE (up to 39%), arterial thromboembolic events (up to 28%), and venous thromboembolic events (up to 57%), exceeding declines in the general population.
• While major bleeding rates decreased (up to 12%), non-major clinically relevant bleeding rates markedly increased, particularly in ND-CKD patients (from 42% to 69%), with greater increases observed in women.

Conclusions:

• Despite significant improvements in reducing cardiovascular and major bleeding event rates, advanced CKD patients still face substantially higher risks than the general population.
• The increasing trend in non-major bleeding events, especially in ND-CKD patients and women, warrants specific attention and targeted interventions.
• Continued development and implementation of strategies are necessary to further mitigate the cardiovascular and bleeding risks in this vulnerable patient group.